{ "hospital_name": "North Vista Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "North Vista Hospital" ], "hospital_address": [ "1409 East Lake Mead Boulevard North Las Vegas, NV 89030" ], "license_information": { "license_number": "200470861", "state": "NV" }, "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": "Vincenzo Variale" }, "type_2_npi": [ "1720037799", "1619050549" ], "standard_charge_information": [ { "description": " - NV006 - ", "code_information": [ { "code": "NV006", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13000, "minimum": 2240, "maximum": 13000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2240 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": " - NV002 - ", "code_information": [ { "code": "NV002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10356.25, "minimum": 2240, "maximum": 10356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2240 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9688, "minimum": 2514, "maximum": 17923.5585, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17245.37, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9688.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9882.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9688.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12594.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9688.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 14532.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17923.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 14532.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14532.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14532.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9688.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9688.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15017.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15501.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15880.27, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9688.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14338.85, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9688.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9688.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8799.62 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9591.53, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": " - S2900 - ", "code_information": [ { "code": "S2900", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9859.5, "minimum": 2240, "maximum": 9859.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2240 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": " - NV005 - ", "code_information": [ { "code": "NV005", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14671.19, "minimum": 2240, "maximum": 14671.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2240 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8359, "minimum": 2560, "maximum": 36679.194, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14879.38, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8526.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10866.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8359.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12538.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15464.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12538.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12538.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12538.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12956.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13374.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13701.56, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12371.62, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4728.66 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8275.61, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11473, "minimum": 3691, "maximum": 71776.242, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 20423.45, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11703.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14916.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11473.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 17210.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 21226.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 17210.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17210.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 17210.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17784.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18358.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18806.87, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16981.3, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11473.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14540.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11359.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9338, "minimum": 2620.8, "maximum": 17276.04, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16622.35, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9338.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9525.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9338.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12139.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9338.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 14007.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17276.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 14007.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14007.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14007.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9338.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9338.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14474.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14941.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15306.57, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9338.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13820.83, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9338.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9338.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6771.87 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9245.02, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7385, "minimum": 2615, "maximum": 29593.152, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13146.67, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7533.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9601.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7385.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11078.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13663.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11078.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11078.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11078.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7650, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11447.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11817.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12106.02, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10930.94, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9496.49 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7311.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9087, "minimum": 3773, "maximum": 20821, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16175.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9087.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9087.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11813.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9087.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13630.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16811.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13630.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13630.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13630.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9087.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9087.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14085.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14539.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14894.86, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9087.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13449.09, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9087.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9087.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11202.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8996.35, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15487, "minimum": 3773, "maximum": 30338, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27568.3, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15797.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20134.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 15487.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 23231.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 28652.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 23231.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23231.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 23231.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24006.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24780.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 25386.05, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22921.96, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7938.83 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 15332.93, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23717, "minimum": 3773, "maximum": 44021, "payers_information": [ { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 38875.35, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 35101.89, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 23717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23717.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30823.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 23480.32, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 42217.13, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 24191.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30832.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 23717.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 35576.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 43877.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 35576.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 35576.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 35576.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 23717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23717.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 36762.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 37947.98, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "Adenosine Iv Soln 6 Mg/2Ml - 25021030104", "drug_information": { "unit": 4, "type": "ML" }, "code_information": [ { "code": "25021030104", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 135, "10th_percentile": 135, "90th_percentile": 135, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7902, "minimum": 3191.61, "maximum": 14618.959, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14065.81, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7902.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8060.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7902.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10272.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7902.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11853.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14618.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11853.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11853.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7902.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7902.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12248.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12643.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12952.4, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7902.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11695.17, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7902.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7902.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3191.61 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7823.12, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18608, "minimum": 3773, "maximum": 34425.207, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 33122.63, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18608.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 18980.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18608.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24190.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 18608.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 27912.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 34425.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 27912.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27912.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27912.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 18608.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18608.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28842.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29773.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30500.7, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18608.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27540.17, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18608.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18608.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20803.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 18422.14, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14641, "minimum": 3773, "maximum": 27086.2385, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26061.35, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14641.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14934.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14641.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19033.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14641.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 21961.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27086.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 21961.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21961.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21961.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14641.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14641.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22693.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23425.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23998.39, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14641.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21668.99, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14641.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14641.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15704.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14494.8, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11228, "minimum": 3773, "maximum": 25429.8, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19986.61, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11228.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11452.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11228.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14596.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11228.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16842.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20772.6, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16842.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16842.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16842.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11228.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11228.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17404.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17965.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18404.47, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11228.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16618.08, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11228.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11228.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25429.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11116.15, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8999, "minimum": 3691, "maximum": 16649.852, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16019.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8999.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9179.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8999.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11699.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8999.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13499.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16649.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13499.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13499.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13499.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8999.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10800, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8999.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13949.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14399.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14751.77, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8999.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13319.88, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8999.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8999.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10587.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8909.92, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46642, "minimum": 3773, "maximum": 93878.4, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 83023.69, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 47575.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 46642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 60635.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 46642.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 69963.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 86288.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 69963.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 69963.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 69963.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 46642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 46642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 72295.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 74628.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 76451.72, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 46642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 69030.93, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 46642.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46642.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 93878.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 46176.09, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7131, "minimum": 2461, "maximum": 13192.905, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12693.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7273.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9270.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10696.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13192.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10696.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10696.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10696.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11053.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11410.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11688.91, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10554.32, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7131.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8479.01 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7059.99, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10704, "minimum": 3773, "maximum": 19803.621, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19054.29, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10918.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13916.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10704.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16056.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19803.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16056.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16057.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16056.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16592.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17127.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17546.07, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15842.9, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10704.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16078.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10597.61, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Adenosine Iv Soln 3 Mg/Ml (Diagnostic)", "drug_information": { "unit": 30, "type": "ML" }, "code_information": [ { "code": "00703877701", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 135, "10th_percentile": 135, "90th_percentile": 135, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11011, "minimum": 3773, "maximum": 20370.387, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19599.62, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11011, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11231.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11011, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14314.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11011.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16516.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20370.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16516.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16516.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16516.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11011, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11011, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17067.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17617.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18048.13, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11011, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16296.31, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11011, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11011.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4977.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10900.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6362, "minimum": 1999, "maximum": 33059.232, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11326.02, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6362.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6490.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6362.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8271.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6362.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 9544.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11771.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 9544.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9544.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9544.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6362.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6362.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9862.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10180.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10429.48, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6362.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9417.14, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6362.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6362.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6424.46 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6299.3, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16789, "minimum": 3773, "maximum": 31059.6685, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29884.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16789, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17124.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16789, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21825.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 16789.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 25183.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 31059.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 25183.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25183.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25183.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 16789, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16789, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26022.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26862.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27518.85, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16789, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24847.73, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16789, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16789.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21241.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 16621.12, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12954, "minimum": 2307, "maximum": 52101.756, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23059.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12954.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13213.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12954.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16840.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12954.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 19431.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 23965.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 19431.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19431.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19431.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12954.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12954.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20079.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20727.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21233.88, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12954.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19172.79, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12954.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12954.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16996.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12825.04, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17743, "minimum": 3773, "maximum": 32825.475, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31583.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 18098.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23066.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 17743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 26615.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32825.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 26615.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26615.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26615.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 14400, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 18000, "10th_percentile": 18000, "90th_percentile": 18000, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27502.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28389.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 29083.37, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26260.38, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29150.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 17566.07, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31228, "minimum": 3773, "maximum": 91558.296, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 55586.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31228.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 31852.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31228.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 40596.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 31228.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 46842.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 57772.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 46842.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 46842.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 46842.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 31228.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 31228.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 48403.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 49965.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 51186.14, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 31228.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 46217.78, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 31228.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31228.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40818.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 30915.95, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19481, "minimum": 3773, "maximum": 36040.183, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 34676.5, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19481.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 19870.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19481.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25325.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 19481.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 29221.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 36040.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 29221.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29221.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 29221.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 19481.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19481.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 30195.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 31169.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 31931.63, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19481.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28832.15, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19481.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19481.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28026.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 19286.37, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13088, "minimum": 3773, "maximum": 45210, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23298.1, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13350.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17015.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13088.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 19633.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24214.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 19633.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19633.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19633.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20287.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20942.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21453.85, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19371.45, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13088.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13088.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7587.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12957.93, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39004, "minimum": 3773, "maximum": 72157.659, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 69427.37, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39004.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 39784.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 39004.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 50705.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 39004.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 58506.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 72157.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 58506.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 58506.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 58506.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 39004.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 39004.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 60456.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 62406.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 63931.62, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 39004.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 57726.13, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 39004.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39004.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55918.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 38614.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Adenosine Iv Soln 6 Mg/2Ml - 63323065102", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "63323065102", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 135, "10th_percentile": 135, "90th_percentile": 135, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15802, "minimum": 3773, "maximum": 29234.44, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 28128.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15802.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 16118.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15802.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20543.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 15802.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 23703.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 29234.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 23703.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23703.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 23703.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 15802.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15802.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24493.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25283.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 25901.71, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15802.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23387.55, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15802.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15802.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12085 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 15644.38, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6600, "minimum": 3773, "maximum": 20302.2, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11748.2, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6600.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6732.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6600.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8580.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6600.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 9900.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12210.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 9900.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9900.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9900.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6600.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6600.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10230.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10560.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10818.24, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6600.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9768.16, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6600.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6600.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20302.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6534.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8700, "minimum": 3115, "maximum": 19631, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15487.74, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8700.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8875, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8700.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11311.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8700.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13051.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16096.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13051.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13051.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13051.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8700.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8700.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13486.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13921.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14261.78, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8700.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12877.45, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8700.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8700.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8613.97, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6511, "minimum": 1982, "maximum": 12492, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11589.88, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6641.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8464.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 9766.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12045.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 9766.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9766.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9766.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10092.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10417.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10672.46, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9636.53, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3977.15 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6446.06, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8051, "minimum": 3773, "maximum": 21286.512, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14331.14, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8212.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10466.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8051.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12076.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14894.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12076.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12076.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12076.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12479.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12881.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13196.72, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11915.78, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8051.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10299.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7970.69, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6918, "minimum": 2768, "maximum": 23431.896, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12314.04, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6918, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7056.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6918, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8993.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6918, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10377, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12798.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10377, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10377, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10377, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6918, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6918, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10722.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11068.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11339.29, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6918, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10238.64, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6918, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6918, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4553.41 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6848.82, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15279, "minimum": 3773, "maximum": 28266.9825, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27197.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15279.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15585.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15279.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19863.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 15279.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 22919.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 28266.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 22919.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22919.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22919.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 15279.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15279.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23683.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24447.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 25044.63, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15279.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22613.59, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15279.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15279.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15873.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 15126.66, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 100403, "minimum": 3773, "maximum": 185746.5305, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 178718.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 100404, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 102412.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 100404, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 130524.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 100403.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 150605.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 185746.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 150605.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 150606, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 150605.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 100404, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 100404, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 155625.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 160645.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 164572.2, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 100404, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 148597.22, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 100404, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 100403.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 121080 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 99399.49, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41963, "minimum": 3773, "maximum": 77631.7905, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 74694.37, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41963.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 42802.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 41963.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 54552.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 41963.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 62944.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 77631.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 62944.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 62944.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 62944.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 41963.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 41963.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 65042.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 67141.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 68781.72, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 41963.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 62105.43, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 41963.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41963.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40796.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 41543.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16833, "minimum": 3773, "maximum": 31141.938, "payers_information": [ { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 16833.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 25250.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 31141.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 25250.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25250.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25250.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 16833.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 25650, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 45000, "10th_percentile": 45000, "90th_percentile": 45000, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16833.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26091.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26933.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27591.79, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16833.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24913.55, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16833.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16833.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15670.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 16665.15, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29963.59, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16833.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17170.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16833.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21883.52, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Follow-Up Surgery", "code_information": [ { "code": "27884", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10163.1, "discounted_cash": 3559, "minimum": 1048.23, "maximum": 10163.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6356.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10163.1, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6762.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6406.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5516.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6805.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1048.23 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5694.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3523.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13111, "minimum": 3773, "maximum": 43137.756, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23337.69, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13373.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17044.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13111.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 19666.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24255.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 19666.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19666.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19666.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20322.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20977.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21490.4, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19404.37, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13111.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14247.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12979.95, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24905, "minimum": 3773, "maximum": 46075.8595, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 44332.45, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24905.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 25404.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24905.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32377.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 24905.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 37358.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 46075.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 37358.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 37358.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 37358.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 24905.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24905.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 38604.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 39849.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 40823.26, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 24905.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36860.69, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 24905.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24905.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21483.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 24656.81, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12831, "minimum": 3773, "maximum": 47700.432, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 22840.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12831.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13088.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12831.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16681.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12831.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 19247.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 23738.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 19247.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19247.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19247.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12831.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12831.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19889.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20531.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21032.77, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12831.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18991.18, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12831.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12831.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17277.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12703.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Amputation Toe & Metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14470.1, "discounted_cash": 3559, "minimum": 636.77, "maximum": 14470.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6356.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11846.16, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6762.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6406.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5516.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6805.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 636.77 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5694.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3523.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30151, "minimum": 3773, "maximum": 55779.4055, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 53668.83, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30151, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 30754.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 30151, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 39196.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 30151.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 45226.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 55779.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 45226.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 45226.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 45226.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 30151, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30151, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 46734.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 48241.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 49420.5, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 30151, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 44623.52, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 30151, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30151.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25311.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 29849.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8600, "minimum": 2615, "maximum": 22776.03, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15308.89, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8772.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11180.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12900.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15910.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12900.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12900.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12900.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13330.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13760.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14097.08, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12728.74, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7607.92 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8514.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12209, "minimum": 3773, "maximum": 37228.986, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21732.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12209.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12209.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15872.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12209.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 18313.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22587.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 18313.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18313.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18313.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12209.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12209.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18924.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19534.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 20012.26, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12209.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18069.73, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12209.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12209.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13853 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12087.19, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14470.08, "discounted_cash": 3559, "minimum": 636.77, "maximum": 14470.08, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6356.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11846.16, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6762.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6406.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5516.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6805.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 636.77 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5694.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3523.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36210, "minimum": 2307, "maximum": 78827.922, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 64454.99, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36210.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 36934.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 36210.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 47073.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 36210.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 54316.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 66989.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 54316.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 54316.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 54316.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 36210.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 6750, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36210.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 56126.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 57937.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 59352.96, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 36210.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 53591.79, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 36210.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36210.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7070.82 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 35848.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20336, "minimum": 3773, "maximum": 37621.637, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 36198.12, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20336, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 20742.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20336, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26436.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 20336.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 30504.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 37621.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 30504.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30504, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 30504.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 20336, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20336, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 31520.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32537.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 33332.74, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20336, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30097.31, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 20336, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20336.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27082.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 20132.66, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 58073, "minimum": 3773, "maximum": 107435.642, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 103370.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 58073.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 59234.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 58073.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 75495.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 58073.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 87109.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 107435.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 87109.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 87109.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 87109.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 58073.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 58073.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 90013.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 92917.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 95187.95, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 58073.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 85948.51, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 58073.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58073.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15555 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 57492.59, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20172, "minimum": 3773, "maximum": 37318.4405, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 35906.39, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20172.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 20575.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20172.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26223.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 20172.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 30258.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 37318.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 30258.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30258.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 30258.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 20172.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20172.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 31266.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32275.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 33064.09, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20172.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29854.75, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 20172.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20172.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21554.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 19970.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7211, "minimum": 3076, "maximum": 31152.888, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12835.9, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7355.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9374.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7211.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10816.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13340.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10816.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10816.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10816.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9000, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11177.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11537.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11819.85, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10672.55, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6805.89 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7139.07, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13895, "minimum": 3773, "maximum": 26960.7, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24734.7, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14173.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18064.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13895.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 20843.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25707.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 20843.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20843.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 20843.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21538.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22233.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22776.77, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20565.93, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26960.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 13756.94, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6974, "minimum": 2768, "maximum": 23542.452, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12415.18, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6974.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7114.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6974.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9067.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6974.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10462.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12903.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10462.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10462.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10462.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6974.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6974.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10810.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11159.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11432.43, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6974.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10322.73, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6974.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6974.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5370.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6905.07, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36784, "minimum": 3773, "maximum": 68051.658, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 65476.73, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36784.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 37520.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 36784.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 47820.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 36784.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 55177.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 68051.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 55177.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 55177.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 55177.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 36784.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36784.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 57016.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 58855.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 60293.8, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 36784.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 54441.33, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 36784.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36784.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59465.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 36416.83, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11150, "minimum": 3773, "maximum": 20627.87, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19847.36, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11150.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11373.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11150.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14495.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11150.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16725.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20627.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16725.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16725.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16725.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11150.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11150.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17282.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17840.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18276.29, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11150.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16502.3, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11150.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11150.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8869.71 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11038.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21153, "minimum": 3773, "maximum": 39134.53, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 37653.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 21576.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27499.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 21153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 31730.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 39134.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 31730.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 31730.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 31730.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 21153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 32788.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 33846.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 34673.19, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31307.62, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29983.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 20942.26, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Av fusion direct any site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26000, "discounted_cash": 3434, "minimum": 983.36, "maximum": 26000, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6133.91, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11431.53, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6525.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6181.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5323.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6567.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 983.36 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1514.36 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1514.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5495.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3060 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2511 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10857, "minimum": 2922, "maximum": 20087.004, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19326.96, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10857.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11074.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10857.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14115.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10857.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16286.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20087, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16286.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16286.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16286.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10857.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10857.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16829.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17372.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17797.02, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10857.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16069.6, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10857.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10857.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17341.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10749.26, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11285, "minimum": 3773, "maximum": 20877.731, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 20087.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11285.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11511.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11285.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14670.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11285.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16927.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20877.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16927.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16927.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16927.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11285.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11285.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17492.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18056.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18497.74, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11285.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16702.18, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11285.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11285.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13311.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11172.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6152, "maximum": 45126.27, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20101.2 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50264, "minimum": 3773, "maximum": 92989.2695, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 89470.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 50264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 51269.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 50264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 65343.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 50264.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 75396.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 92989.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 75396.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 75396.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 75396.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 50264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 77909.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 80423.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 82388.54, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 50264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 74391.42, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 50264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50264.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51780.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 49761.83, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46168, "minimum": 3773, "maximum": 85411.096, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 82179.32, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 47091.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 46168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 60018.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 46168.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 69252.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 85411.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 69252.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 69252.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 69252.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 46168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 46168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 71560.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 73869.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 75674.3, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 46168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 68328.88, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 46168.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46168.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69067.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 45706.48, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Av Fistula Revision Open", "code_information": [ { "code": "36832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000, "discounted_cash": 6052, "minimum": 1642, "maximum": 18000, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10809.93, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18000, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8473.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 11499.92, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11197.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9078.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10894.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9381.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11574.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1660.7 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 2607.06 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 2607.06 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9684.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1677.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5992.06, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4661 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3303 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12105.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22671, "minimum": 3773, "maximum": 41942.4415, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 40355.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 23125.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29473.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 22671.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 34007.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 41942.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 34007.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 34007.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 34007.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 35140.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 36274.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 37161.02, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33553.95, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26257.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 22444.87, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32209, "minimum": 3773, "maximum": 59586.7795, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 57332.14, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32209.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 32853.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 32209.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41871.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 32209.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 48313.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 59586.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 48313.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 48313.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 48313.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 32209.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 32209.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 49924.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 51534.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 52793.94, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 32209.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 47669.42, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 32209.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32209.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33970.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 31886.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21683, "minimum": 3773, "maximum": 40114.179, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 38596.35, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 22116.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28188.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 21683.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 32525.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 40114.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 32525.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 32524.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 32525.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 21683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 33609.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34693.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 35541.1, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32091.34, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21683.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21683.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20547.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 21466.51, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13733, "minimum": 3076, "maximum": 42880.788, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24445.91, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13733.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14008.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13733.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17853.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13733.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 20600.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25407.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 20600.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20600.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 20600.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13733.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13733.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21287.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21973.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22510.91, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13733.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20325.82, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13733.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13733.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17998.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 13596.32, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46915, "minimum": 3773, "maximum": 86792.9535, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 83508.9, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 47853.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 46915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 60989.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 46915.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 70372.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 86792.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 70372.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 70372.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 70372.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 46915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 46915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 72718.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 75064.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 76898.54, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 46915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 69434.36, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 46915.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46915.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 70220.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 46445.96, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11067, "minimum": 3773, "maximum": 20475.504, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19700.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11067.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11289.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11067.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14388.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11067.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16601.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20475.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16601.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16601.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16601.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11067.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11067.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17155.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17708.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18141.23, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11067.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16380.4, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11067.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11067.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14447.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10957.16, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17903, "minimum": 3773, "maximum": 33121.0495, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31867.82, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17903.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 18261.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17903.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23274.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 17903.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 26854.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 33121.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 26854.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26854.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26854.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 17903.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17903.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27750.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28645.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 29345.3, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17903.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26496.84, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17903.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17903.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22973.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 17724.24, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14506, "minimum": 3773, "maximum": 26836.359, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25820.93, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14506.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14796.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14506.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18857.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14506.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 21759.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26836.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 21759.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21759.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21759.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14506.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14506.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22484.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23209.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23776.95, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14506.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21469.09, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14506.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14506.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21369.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14361.08, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9428, "minimum": 3773, "maximum": 27355.14, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16783.6, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9428.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9617.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9428.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12257.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9428.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 14143.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17443.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 14143.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14143.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14143.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9428.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9428.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14614.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15086.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15455.06, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9428.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13954.91, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9428.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9428.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7540.91 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9334.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19361, "minimum": 3773, "maximum": 35819.2745, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 34463.95, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19361.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 19749.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19361.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25170.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 19361.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 29042.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 35819.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 29042.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29042.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 29042.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 19361.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19361.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 30010.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30978.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 31735.93, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19361.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28655.42, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19361.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19361.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27929.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 19168.15, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30414, "minimum": 3773, "maximum": 56266.936, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 54137.92, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30414.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 31022.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 30414.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 39538.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 30414.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 45621.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 56266.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 45621.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 45621.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 45621.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 30414.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30414.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 47142.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 48663.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 49852.57, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 30414.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 45013.55, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 30414.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30414.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34017.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 30110.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Bupivacaine 0.75% In Dextrose Inj 8.25%", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "00409361301", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "1 through 10" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30795, "minimum": 3773, "maximum": 60125.2, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 54815.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30795, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 31410.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 30795, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 40033.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 30795.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 46192.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 56970.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 46192.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 46192.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 46192.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 30795, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30795, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 47732.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 49272.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 50476.08, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 30795, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 45576.66, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 30795, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30795.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60125.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 30487.09, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22671, "minimum": 3773, "maximum": 41942.4415, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 40355.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 23125.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29473.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 22671.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 34007.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 41942.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 34007.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 34007.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 34007.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 35140.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 36274.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 37161.02, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33553.95, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22671.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20078.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 22444.87, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12106, "minimum": 3773, "maximum": 22396.7105, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21549.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12106.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12348.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12106.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15738.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12106.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 18159.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22396.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 18159.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18159.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18159.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12106.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12106.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18764.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19370.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19843.44, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12106.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17917.37, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12106.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12106.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14944.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11985.27, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.25%", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "00409116001", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29880, "minimum": 3773, "maximum": 55279.6835, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 53188.02, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 30478.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 29880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38845.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 29880.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 44821.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 55279.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 44821.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 44821.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 44821.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 29880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 29880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 46315.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 47809.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 48977.78, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 29880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 44223.75, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 29880.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29880.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46049.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 29582.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18521, "minimum": 3773, "maximum": 34265.2375, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 32968.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18521.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 18892.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18521.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24078.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 18521.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 27782.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 34265.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 27782.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27782.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27782.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 18521.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18521.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28708.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29634.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30359.08, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18521.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27412.19, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18521.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18521.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12656.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 18336.53, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6948, "minimum": 3230, "maximum": 14060.034, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12368.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7087.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9033.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6948.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10422.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12854.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10422.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10422.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10422.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9450, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10770.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11117.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11389.24, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10283.74, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6948.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4874.02 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6878.99, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.5% - 00409116301", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "00409116301", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16739, "minimum": 3773, "maximum": 30968.26, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29796.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16739.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17074.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16739.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21761.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 16739.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 25109.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 30968.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 25109.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25109.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25109.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 16739.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16739.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25946.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26783.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27437.88, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16739.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24774.61, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16739.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16739.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17265.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 16572.2, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7376, "minimum": 3691, "maximum": 22154.526, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13130.54, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7524.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9589.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7376.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11065.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13646.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11065.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11065.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11065.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11433.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11802.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12091.17, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10917.53, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7376.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4016.32 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7302.94, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.25%", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00409115901", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "1 through 10" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.5% - 00409116202", "drug_information": { "unit": 30, "type": "ML" }, "code_information": [ { "code": "00409116202", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "1 through 10" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23337, "minimum": 3384, "maximum": 43173.487, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 41539.9, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23337, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 23803.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23337, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30338.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 23337.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 35005.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 43173.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 35005.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 35005.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 35005.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 23337, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23337, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 36172.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 37339.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 38251.68, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23337, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 34538.79, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 23337, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23337.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24496.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 23103.65, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.5% - 00409156010", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00409156010", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "1 through 10" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19060, "minimum": 3773, "maximum": 35261.6475, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 33927.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19060.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 19441.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19060.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24778.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 19060.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 28590.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 35261.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 28590.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28590.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 28590.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 19060.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19060.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29543.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30496.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 31241.74, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19060.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28209.32, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19060.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19060.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32965.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 18869.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8266, "minimum": 3773, "maximum": 19747.692, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14715.21, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8432.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10747.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8266.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12400.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15293.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12400.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12400.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12400.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12813.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13227.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13550.39, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12235.12, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5733.77 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8184.3, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.75%", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00409158210", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "1 through 10" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17317, "minimum": 3384, "maximum": 32037.8005, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 30825.56, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17317.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17664.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17317.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22513.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 17317.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 25976.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32037.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 25976.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25976.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25976.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 17317.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17317.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26842.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27708.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28385.44, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17317.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25630.24, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17317.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17317.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31182.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 17144.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5178, "minimum": 1692, "maximum": 10752.318, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 9218.03, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 5282.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 6732.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 5178.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 7768.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 9580.54, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 7768.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 7768.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 7768.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 8026.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8285.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 8488.36, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 7664.43, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5178.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5054.42 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 5126.88, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.5% - 63323046757", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "63323046757", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7489, "minimum": 3537, "maximum": 13855.649, "payers_information": [ { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12276.11, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11084.52, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5472.96 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7414.64, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13331.38, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7639.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9736.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11234.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13855.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11234.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11234.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11234.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10350, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7489.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11608.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11983.26, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27307, "minimum": 3773, "maximum": 50518.5605, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 48607.05, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 27853.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35499.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 27307.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 40961, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 50518.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 40961, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 40960.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 40961, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 27307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 27307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 42326.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 43691.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 44759.4, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 40414.85, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 27307.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27307.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32102.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 27034.26, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11346, "minimum": 3773, "maximum": 20990.47, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 20196.24, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11346.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11573.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11346.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14750.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11346.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 17019.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20990.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 17019.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17019.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 17019.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11346.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11346.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17586.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18153.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18597.56, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11346.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16792.38, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11346.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11346.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9887.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11232.74, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28218, "minimum": 3773, "maximum": 60907.6, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 50229.8, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28219, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 28783.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28219, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 36684.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 28218.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 42328.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 52205.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 42328.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 42328.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 42328.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 28219, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 28219, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 43739.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 45150.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 46253.76, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 28219, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 41764.11, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 28219, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28218.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60907.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 27936.8, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55581, "minimum": 3537, "maximum": 114713.802, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 98934.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 56692.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 72255.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 55581.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 83371.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 102825.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 83371.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 83371.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 83371.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 86150.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 88930.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 91103.31, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 82260.28, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68076.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 55025.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55581, "minimum": 3773, "maximum": 102825.3495, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 98934.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 56692.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 72255.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 55581.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 83371.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 102825.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 83371.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 83371.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 83371.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 86150.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 88930.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 91103.31, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 82260.28, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55581.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54143 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 55025.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45348, "minimum": 3773, "maximum": 83895.1505, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 80720.74, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45348.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 46255.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 45348.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 58953.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 45348.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 68023.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 83895.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 68023.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 68023.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 68023.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 45348.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 45348.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 70290.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 72557.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 74331.05, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 45348.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 67116.12, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 45348.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45348.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54033.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 44895.24, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 81996, "minimum": 3773, "maximum": 151693.488, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 145953.73, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 81996.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 83636.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 81996.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 106595.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 81996.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 122994.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 151693.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 122994.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 122994.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 122994.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 81996.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 81996.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 127094.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 131194.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 134400.46, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 81996.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 121354.79, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 81996.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 81996.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 118319 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 81176.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33307, "minimum": 3773, "maximum": 61619.208, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 59287.67, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33307.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 33973.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 33307.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43299.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 33307.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 49961.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 61619.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 49961.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 49961.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 49961.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 33307.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33307.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 51626.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 53292.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 54594.65, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 33307.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49295.37, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 33307.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33307.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44498.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 32974.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17430, "minimum": 1846, "maximum": 32246.5175, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31026.38, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17779.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22659.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 17430.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 26145.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32246.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 26145.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26145.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26145.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 17430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27017.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27888.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28570.33, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25797.21, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17430.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23202.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 17256.24, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6652, "minimum": 1999, "maximum": 15948.45, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11840.56, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6652, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6785.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6652, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8647.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6652, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 9978, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12306.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 9978, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9978, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9978, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6652, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6652, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10310.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10643.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10903.29, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6652, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9844.96, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6652, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6652, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8060.47 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6585.48, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6092, "minimum": 2768, "maximum": 11271.6985, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10845.2, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6092.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6214.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6092.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7920.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6092.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 9139.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 11271.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 9139.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9139.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9139.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6092.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8100, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6092.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9443.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9748.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9986.72, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6092.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9017.36, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6092.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6092.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4649.28 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6031.88, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14293, "minimum": 3076, "maximum": 26443.2895, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25442.73, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14579.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18581.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14293.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 21440.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26443.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 21440.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21440.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21440.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22155.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22869.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23428.8, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21154.63, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14293.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23766 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14150.73, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60152, "minimum": 3773, "maximum": 111282.6245, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 107071.93, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 60152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 61355.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 60152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 78198.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 60152.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 90229.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 111282.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 90229.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 90229.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 90229.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 60152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 60152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 93236.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 96244.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 98596.45, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 60152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 89026.1, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 60152.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60152.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67131.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 59551.24, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14408, "minimum": 3773, "maximum": 26655.059, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25646.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14696.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18730.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14408.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 21612.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26655.06, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 21612.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21612.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21612.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22332.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23053.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23616.32, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21324.05, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17134.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14264.06, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39466, "minimum": 3773, "maximum": 83159.028, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 70249.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 40255.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 39466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 51306, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 39466.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 59199.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 73012.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 59199.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 59199.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 59199.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 39466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 39466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 61172.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 63145.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 64689.05, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 39466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 58409.9, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 39466.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39466.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55230.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 39071.49, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8951, "minimum": 3384, "maximum": 16559.9605, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15933.37, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8951.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9130.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8951.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11636.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8951.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13427, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16559.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13427, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13427, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13427, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8951.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8951.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13874.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14322.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14672.13, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8951.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13247.97, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8951.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8951.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9136.71 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8861.82, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14853, "minimum": 3076, "maximum": 45677.556, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26439.55, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14853.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15150.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14853.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19309.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14853.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 22280.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27479.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 22280.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22280.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22280.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14853.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14853.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23023.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23765.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24346.7, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14853.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21983.45, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14853.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14853.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17368.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14705.14, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50897, "minimum": 3773, "maximum": 94160.8745, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 90598.03, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 50897.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 51915.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 50897.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 66167.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 50897.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 76346.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 94160.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 76346.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 76346.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 76346.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 50897.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50897.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 78891.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 81436.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 83426.58, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 50897.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 75328.7, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 50897.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50897.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38838.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 50388.79, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42939, "minimum": 3773, "maximum": 79437.224, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 76431.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42939, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 43797.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 42939, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 55820.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 42939.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 64408.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 79437.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 64408.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 64408.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 64408.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 42939, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 42939, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 66555.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 68702.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 70381.31, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 42939, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 63549.78, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 42939, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42939.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44981.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 42509.65, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 250 Mg", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00409733701", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18083, "minimum": 3691, "maximum": 48596.832, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 32188.84, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18083.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 18445.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18083.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23508.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 18083.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 27125.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 33454.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 27125.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27125.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27125.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 18083.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18083.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28029.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28933.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 29640.83, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18083.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26763.76, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18083.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18083.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20112.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 17902.78, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8602, "minimum": 3773, "maximum": 21993.174, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15313.29, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8775.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11183.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8602.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12904.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15915.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12904.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12904.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12904.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13950, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13334.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13764.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14101.13, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12732.4, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8602.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5888.41 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8516.94, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16999, "minimum": 3773, "maximum": 31449.704, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 30259.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17339.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22099.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 16999.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 25499.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 31449.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 25499.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25499.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25499.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 16999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26349.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27199.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27864.37, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25159.76, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16999.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16999.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28597.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 16829.84, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10628, "minimum": 2560, "maximum": 19661.9295, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18917.96, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10628.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10840.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10628.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13816.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10628.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 15942.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19661.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 15942.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15942.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15942.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10628.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10628.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16473.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17420.52, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10628.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15729.54, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10628.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10628.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14013.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10521.79, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 10334 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 64664, "minimum": 3773, "maximum": 119630.213, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 115103.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 64665, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 65958.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 64665, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 84064.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 64664.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 96997.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 119630.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 96997.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 96997.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 96997.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 64665, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 64665, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 100230.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 103463.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 105992.4, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 64665, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 95704.17, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 64665, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 64664.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78418.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 64018.33, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40996, "minimum": 3773, "maximum": 75843.1365, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 72973.4, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 41816.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 40996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53295.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 40996.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 61494.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 75843.14, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 61494.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 61494.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 61494.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 40996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 40996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 63544.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 65594.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 67197.04, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 40996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 60674.51, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 40996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40996.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52450.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 40586.33, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21117, "minimum": 2922, "maximum": 39067.486, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 37589.26, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 21539.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27452.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 21117.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 31676.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 39067.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 31676.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 31676.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 31676.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 21117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 32732.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 33788.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 34613.86, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31253.99, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21117.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21117.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28340 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 20906.38, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18621, "minimum": 3773, "maximum": 34449.59, "payers_information": [ { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 18621.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 27932.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 34449.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 27932.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27932.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27932.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 18621.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18621.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28863.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29794.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30522.34, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18621.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27559.67, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18621.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18621.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16029.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 18435.19, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 33146.09, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18621.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 18993.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18621.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24207.82, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13321, "minimum": 3773, "maximum": 48329.406, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23712.96, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13588.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17318.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13321.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 19982.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24645.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 19982.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19982.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19982.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20648.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21315.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21835.93, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19716.4, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13321.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13321.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10602.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 13188.67, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Ceftriaxone Iv Syringe In Ns", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "99999070325", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 10 Gm", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "60505615005", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12204, "minimum": 3773, "maximum": 22578.029, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21723.73, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12204.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12448.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12204.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15865.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12204.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 18306.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22578.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 18306.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18306.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18306.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12204.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12204.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18916.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19526.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 20004.07, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12204.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18062.42, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12204.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12204.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9316.09 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12082.3, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 Gm - 00143985701", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00143985701", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 357060, "minimum": 3773, "maximum": 660561.9435, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 635567.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 357061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 364202.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 357061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 464178.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 357060.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 535590.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 660561.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 535590.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 535591.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 535590.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 357061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 357061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 553443.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 571296.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 585258.69, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 357061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 528449.55, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 357061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 357060.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 374441 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 353489.9, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 Gm - 00143985625", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00143985625", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 Gm - 60505075304", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "60505075304", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13135, "minimum": 3773, "maximum": 24301.1745, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23381.67, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13135.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13398.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13135.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17076.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13135.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 19703.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24301.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 19703.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19703.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19703.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13135.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13135.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20360.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21017.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21530.89, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13135.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19440.94, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13135.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13135.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13084 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 13004.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 500 Mg", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00409733801", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15015, "minimum": 2560, "maximum": 27777.9165, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26726.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15315.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19519.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 15015.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 22522.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27777.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 22522.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22522.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22522.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 15015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23273.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24611.25, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22222.33, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15015.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15015.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14864.94, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 10334 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9326, "minimum": 2560, "maximum": 19593, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16601.83, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9513.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12124.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9326.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13990.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17254.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13990.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13990.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13990.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14456.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15287.67, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13803.77, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9326.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10241.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9233.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 10334 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18745, "minimum": 3773, "maximum": 34679.6375, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 33367.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18745.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 19120.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18745.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24369.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 18745.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 28118.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 34679.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 28118.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28118.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 28118.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 18745.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18745.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29055.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29993.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30726.24, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18745.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27743.71, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18745.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18745.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24391.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 18558.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25693, "minimum": 3773, "maximum": 47532.383, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 45733.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25693.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 26207.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25693.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 33401.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 25693.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 38539.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 47532.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 38539.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 38539.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 38539.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 25693.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25693.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 39824.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 41109.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 42113.72, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 25693.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 38025.91, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 25693.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25693.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28425.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 25436.25, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22781, "minimum": 3773, "maximum": 42145.072, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 40550.39, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22781.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 23236.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22781.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29615.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 22781.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 34171.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 42145.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 34171.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 34171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 34171.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 22781.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22781.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 35310.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 36449.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 37340.5, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22781.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 33716.06, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 22781.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22781.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16075.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 22553.31, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15105, "minimum": 3773, "maximum": 27945.508, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26888.11, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15407.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19637.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 15105.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 22658.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27945.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 22658.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22658.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22658.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 15105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23413.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24169.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24759.75, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22356.41, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15105.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19023.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14954.62, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21649, "minimum": 2560, "maximum": 40051.7045, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 38536.23, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21649.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 22082.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21649.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28144.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 21649.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 32474.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 40051.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 32474.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 32474.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 32474.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 21649.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21649.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 33556.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 35485.86, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21649.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32041.36, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21649.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21649.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15005.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 21433.07, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 10334 } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7360, "minimum": 2615, "maximum": 13616.444, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13101.23, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7360.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7507.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7360.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9568.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7360.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11040.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13616.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11040.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11040.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11040.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7360.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7650, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7360.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11408.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11776.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12064.17, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7360.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10893.16, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7360.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7360.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6756.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7286.64, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8373, "minimum": 3773, "maximum": 15490.42, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14904.3, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8540.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10885.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8373.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12559.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15490.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12559.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12559.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12559.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12978.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13397.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13724.51, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12392.34, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8282.11 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8289.47, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9318, "minimum": 2560, "maximum": 19593, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16587.16, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9318.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9505, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9318.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12114.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9318.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13977.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17239.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13977.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13977.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13977.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9318.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9318.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14443.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15274.17, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9318.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13791.57, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9318.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9318.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7855.33 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9225.44, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 10334 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30770, "minimum": 3773, "maximum": 56925.1105, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 54771.19, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30770.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 31385.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 30770.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 40001.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 30770.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 46155.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 56925.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 46155.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 46155.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 46155.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 30770.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30770.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 47694.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 49232.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 50435.6, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 30770.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 45540.09, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 30770.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30770.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40093.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 30462.63, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17639, "minimum": 3773, "maximum": 32633.5005, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31398.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17992.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22931.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 17639.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 26459.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32633.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 26459.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26459.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26459.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 22050, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27341.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28223.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28913.23, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26106.8, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20421.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 17463.33, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Clindamycin Phosphate In Nacl 0.9% Iv Soln 600 Mg/50Ml", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "00338954924", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 108.6, "10th_percentile": 108.6, "90th_percentile": 108.6, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18450, "minimum": 3773, "maximum": 34134.202, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 32842.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18450.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 18819.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18450.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23986.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 18450.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 27676.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 34134.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 27676.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27676.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27676.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 18450.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18450.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28598.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29521.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30242.87, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18450.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27307.36, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18450.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18450.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23145.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 18266.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7298, "minimum": 3230, "maximum": 13502.188, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12991.29, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7444.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9488.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7298.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10947.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13502.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10947.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10947.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10947.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11312.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11677.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11962.94, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10801.75, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7298.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6853.31 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7225.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Clindamycin Phosphate Inj 900 Mg/6Ml", "drug_information": { "unit": 6, "type": "ML" }, "code_information": [ { "code": "00009090211", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 108.6, "10th_percentile": 108.6, "90th_percentile": 108.6, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12658, "minimum": 3773, "maximum": 23421.7, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 22531.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12658.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12911.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12658.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16455.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12658.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 18987.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 23417.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 18987.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18987.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18987.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12658.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12658.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19620.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20252.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 20747.89, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12658.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18734, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12658.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12658.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23421.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12531.53, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Clindamycin Phosphate In D5W Iv Soln 600 Mg/50Ml", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "00781328991", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 108.6, "10th_percentile": 108.6, "90th_percentile": 108.6, "count": "1 through 10" } ] } ] }, { "description": "Ceftriaxone Iv Syringe In Sw", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "99999070125", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10553, "minimum": 3773, "maximum": 19637.136, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18784.57, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10764.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13719.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10553.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 15829.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19523.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 15829.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15829.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15829.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16357.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16885.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17297.59, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15618.63, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10553.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9308.87 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10447.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Clindamycin Phosphate In D5W Iv Soln 900 Mg/50Ml", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "00781329091", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 108.6, "10th_percentile": 108.6, "90th_percentile": 108.6, "count": "1 through 10" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 Gm - 00004196401", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00004196401", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6717, "minimum": 3230, "maximum": 12428.078, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11957.83, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6852.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8733.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6717.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10076.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12428.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10076.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10076.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10076.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10412.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10748.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11011.28, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9942.46, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6717.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5161.63 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6650.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Clindamycin Phosphate In Nacl 0.9% Iv Soln 900 Mg/50Ml", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "00338955350", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 108.6, "10th_percentile": 108.6, "90th_percentile": 108.6, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8024, "minimum": 3691, "maximum": 14844.437, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14282.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8024.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8184.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8024.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10431.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8024.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12036.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14844.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12036.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12036.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12036.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8024.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8024.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12437.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12838.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13152.17, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8024.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11875.55, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8024.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8024.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6112.11 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7943.78, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 Gm - 00409733201", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00409733201", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10243, "minimum": 3230, "maximum": 40430.628, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18233.39, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10243.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10448.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10243.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13316.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10243.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 15365.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18950.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 15365.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15365.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15365.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10243.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9450, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10243.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15877.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16389.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16790.12, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10243.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15160.35, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10243.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10243.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12495.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10141.05, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17590, "minimum": 3773, "maximum": 32542.092, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31310.77, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17590.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17942.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17590.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22867.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 17590.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 26385.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32542.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 26385.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26385.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26385.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 17590.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17590.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27265, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28144.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28832.26, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17590.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26033.67, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17590.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17590.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15432.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 17414.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21868, "minimum": 3773, "maximum": 40456.984, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 38926.18, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 22305.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28429.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 21868.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 32802.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 40456.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 32802.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 32802.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 32802.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 21868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 33896.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34989.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 35844.82, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32365.59, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21868.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24987.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 21649.95, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 Gm - 64679070301", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "64679070301", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 275.7, "10th_percentile": 2, "90th_percentile": 547.86, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7100, "minimum": 3230, "maximum": 26136.036, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12638, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7242, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9230, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10650, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13135, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10650, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10650, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10650, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11005, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11360, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11637.61, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10508, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6196.64 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7029, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Cor Hlx Vlgs Dstl Mtar Osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13986, "discounted_cash": 3559, "minimum": 1048.23, "maximum": 13986, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6356.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11846.16, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6762.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6406.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5516.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6805.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1048.23 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5694.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3523.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3060 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2511 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10353, "minimum": 3773, "maximum": 19154.5855, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18429.82, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10353.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10560.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10353.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13459.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10353.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 15530.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19154.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 15530.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15530.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15530.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10353.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10353.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16048.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16566.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16970.91, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10353.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15323.67, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10353.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10353.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10350.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10250.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10929, "minimum": 3773, "maximum": 20219.5565, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19454.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11148.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14208.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10929.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16394.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20219.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16394.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16394.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16394.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16940.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17487.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17914.54, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16175.65, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10929.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12956.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10820.2, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46418, "minimum": 3773, "maximum": 87676.884, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 82624.95, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46418.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 47346.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 46418.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 60344.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 46418.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 69627.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 85874.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 69627.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 69627.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 69627.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 46418.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 46418.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 71948.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 74269.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 76084.56, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 46418.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 68699.39, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 46418.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46418.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66352.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 45954.32, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41197, "minimum": 3773, "maximum": 76214.894, "payers_information": [ { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 67526.33, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 41197.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 60971.92, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 41197.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41197.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45412.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 40785.27, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 73331.09, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41197.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 42021.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 41197.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53556.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 41197.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 61795.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 76214.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 61795.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 61795.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 61795.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 41197.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 41197.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 63855.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 65915.58, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 90983, "minimum": 3773, "maximum": 168320.0855, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 161951.22, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 90983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 92803.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 90983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 118278.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 90983.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 136475.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 168320.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 136475.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 136475.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 136475.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 90983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 90983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 141024.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 145574.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 149131.55, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 90983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 134656.07, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 90983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 90983.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 124656 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 90073.99, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8317, "minimum": 3691, "maximum": 28847.646, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14804.62, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8317.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8483.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8317.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10812.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8317.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12475.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15386.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12475.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12475.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12475.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8317.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8317.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12891.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13307.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13632.72, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8317.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12309.46, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8317.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8317.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8330.56 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8234.03, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49761, "minimum": 3773, "maximum": 92058.368, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 88575.08, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49761.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 50756.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 49761.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 64689.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 49761.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 74641.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 92058.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 74641.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 74641.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 74641.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 49761.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 49761.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 77129.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 79618.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 81563.75, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 49761.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 73646.69, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 49761.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49761.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62341.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 49263.67, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21535, "minimum": 2461, "maximum": 39841.452, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 38333.94, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21535.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 21966.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21535.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27996.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 21535.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 32303.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 39841.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 32303.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 32303.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 32303.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 21535.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7200, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21535.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 33380.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34457.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 35299.49, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21535.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31873.16, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21535.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21535.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24287.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 21320.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10478, "minimum": 3773, "maximum": 19384.6515, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18651.18, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10478.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10687.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10478.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13621.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10478.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 15717.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19384.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 15717.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15717.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15717.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10478.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10478.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16241.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16765.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17174.82, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10478.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15507.72, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10478.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10478.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15681.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10373.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Cor Hlx Vlgs Double Osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000, "discounted_cash": 7892, "minimum": 1048.23, "maximum": 18000, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15785.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1862 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8050.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14096.38, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18000, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2434.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 14996.15, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14601.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14206.88, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12233.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 15093.23, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2474.76 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1048.23 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12628.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2424.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 7813.78, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3060 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2511 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2499.76 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37068, "minimum": 3773, "maximum": 68577.2985, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 65982.48, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 37810.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 37068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 48189.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 37068.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 55603.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 68577.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 55603.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 55603.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 55603.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 37068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 57456.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 59310.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 60759.47, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 37068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 54861.84, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 37068.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37068.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54523.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 36698.12, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10161, "minimum": 2560, "maximum": 19593, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18086.79, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10161.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10364.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10161.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13209.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10161.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 15241.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18798.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 15241.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15241.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15241.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10161.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10161.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15749.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16655.06, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10161.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15038.46, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10161.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10161.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9467.62 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10059.51, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 10334 } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12563, "minimum": 3773, "maximum": 26237.628, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 22362.85, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12814.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16332.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12563.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 18845.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 23242.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 18845.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18845.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18845.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19473.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20101.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 20592.67, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18593.83, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12563.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16142.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12437.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Cor hlx vlgs prx phlx osteot", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17897.71, "discounted_cash": 7892, "minimum": 1048.23, "maximum": 17897.71, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15785.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8050.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14096.38, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 17897.71, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11049.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 14996.15, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14601.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11839.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14206.88, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12233.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 15093.23, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1048.23 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 3181.94 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 3181.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12628.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7892.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 7813.78, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3060 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2511 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27380, "minimum": 3537, "maximum": 74511.756, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 48737.5, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27380.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 27928.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27380.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35594.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 27380.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 41070.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 50654.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 41070.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 41070.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 41070.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 27380.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 27380.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 42439.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 43808.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 44879.54, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27380.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 40523.32, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 27380.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27380.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41099.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 27106.81, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8425, "minimum": 3773, "maximum": 40479.93, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14998.12, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8425.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8594.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8425.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10953.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8425.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12638.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15587.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12638.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12638.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12638.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8425.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8425.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13060.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13481.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13810.91, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8425.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12470.35, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8425.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8425.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7513.08 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8341.65, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Cor Hlx Vlgs Rsc Prx Phlx Bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 3559, "minimum": 1048.23, "maximum": 11737, "payers_information": [ { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1048.23 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5694.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3523.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3060 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2511 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6356.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11737, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6762.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6406.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5516.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6805.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51358, "minimum": 3773, "maximum": 114219.288, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 91418.95, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51359, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 52386.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 51359, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 66766.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 51358.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 77038.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 95014.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 77038.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 77038.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 77038.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 51359, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 51359, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 79606.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 82174.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 84182.54, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 51359, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 76011.26, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 51359, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51358.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69901.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 50845.37, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27869, "minimum": 3773, "maximum": 51559.1485, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 49608.26, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 28427.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 36230.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 27869.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 41804.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 51559.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 41804.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 41804.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 41804.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 43198.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 44591.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 45681.39, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 41247.32, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32750.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 27591.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 70854, "minimum": 3773, "maximum": 131081.269, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 126121.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 70854.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 72271.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 70854.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 92111.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 70854.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 106282.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 131081.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 106282.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 106282.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 106282.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 70854.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 70854.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 109824.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 113367.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 116137.94, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 70854.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 104865.02, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 70854.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 70854.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61072.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 70146.19, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9919, "minimum": 3773, "maximum": 18351.667, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17657.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10118.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12895.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9919.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 14879.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18351.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 14879.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14879.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14879.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 12600, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15375.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15871.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16259.58, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14681.33, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9919.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9659.37 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9820.62, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Corrj Halux Rigdus W/O Implt", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 3559, "minimum": 1048.23, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6356.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11737, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6762.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6406.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5516.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6805.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1048.23 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5694.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1058.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3523.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27036, "minimum": 3773, "maximum": 50017.303, "payers_information": [ { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 44315.36, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27036.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 40013.84, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 27036.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27036.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29279.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 26766.02, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 48124.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27036.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 27577.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27036.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35147.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 27036.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 40554.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 50017.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 40554.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 40554.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 40554.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 27036.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 27036.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 41906.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 43258.21, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14642, "minimum": 3773, "maximum": 27089.2725, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26064.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14642.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14935.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14642.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19035.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14642.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 21964.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27089.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 21964.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21964.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21964.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14642.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14642.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22696.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23428.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24001.18, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14642.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21671.42, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14642.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14642.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15512.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14496.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22207, "minimum": 2461, "maximum": 41084.689, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 39530.13, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 22652.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28870.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 22207.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 33311.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 41084.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 33311.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 33311.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 33311.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 22207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 34422.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 35532.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 36400.97, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32867.75, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 22207.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22207.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29230.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 21985.86, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38874, "minimum": 3773, "maximum": 71918.454, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 69197.22, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 39652.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 38874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 50537.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 38874.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 58312.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 71918.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 58312.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 58312.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 58312.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 38874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 60256, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 62199.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 63719.68, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 38874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 57534.76, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 38874.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38874.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44043.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 38486.09, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28634, "minimum": 3773, "maximum": 52974.528, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 50970.09, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28634.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 29207.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28634.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 37225.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 28634.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 42952.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 52974.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 42952.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 42952.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 42952.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 28634.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 28634.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 44384.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 45815.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 46935.46, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 28634.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 42379.62, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 28634.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28634.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31312 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 28348.53, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 56864, "minimum": 3773, "maximum": 105199.066, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 101218.56, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 56864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 58001.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 56864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 73923.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 56864.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 85296.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 105199.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 85296.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 85296.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 85296.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 56864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 56864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 88139.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 90982.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 93206.44, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 56864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 84159.25, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 56864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56864.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 103190 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 56295.72, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33646, "minimum": 3773, "maximum": 62246.913, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 59891.62, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33647, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 34319.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 33647, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43741.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 33646.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 50470.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 62246.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 50470.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 50470.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 50470.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 33647, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33647, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 52152.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 53835.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 55150.8, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 33647, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49797.53, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 33647, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33646.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40185.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 33310.51, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48622, "minimum": 3773, "maximum": 89951.292, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 86547.73, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48622.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 49594.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 48622.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 63209.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 48622.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 72933.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 89951.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 72933.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 72933.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 72933.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 48622.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 48622.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 75364.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 77795.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 79696.81, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 48622.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 71961.03, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 48622.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48622.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65249.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 48136.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19654, "minimum": 3773, "maximum": 36360.122, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 34984.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19654.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 20047.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19654.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25550.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 19654.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 29481.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 36360.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 29481.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29481.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 29481.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 19654.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19654.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 30463.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 31446.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 32215.04, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19654.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29088.1, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19654.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19654.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21013.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 19457.58, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10129, "minimum": 3773, "maximum": 18738.65, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18029.62, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10331.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13167.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 15193.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18738.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 15193.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15193.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15193.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15699.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16206.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16602.44, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14990.92, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10129, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10404.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10027.71, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18305, "minimum": 3773, "maximum": 33866.063, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 32584.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18306, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 18672.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18306, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23797.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 18305.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 27458.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 33866.06, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 27458.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 27459, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27458.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 18306, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18306, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 28374.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29289.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30005.36, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18306, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27092.85, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18306, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18305.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15714.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 18122.92, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10798, "minimum": 2922, "maximum": 25952.274, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19221.4, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11014.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14038.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10798.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16197.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19977.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16197.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16197.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16197.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16737.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17277.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17699.82, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15981.84, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4484.34 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10690.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Dbrdmt Subq Tis 1St 20Sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10163.1, "discounted_cash": 442, "minimum": 98.69, "maximum": 10163.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 884.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 451.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 789.72, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 99.69 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1471.76, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 840.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 795.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 99.69 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 685.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 845.56, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.69 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 187.6 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 187.6 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 707.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 99.69 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 99.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 437.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1048 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1055 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Decompression of tibia nerve", "code_information": [ { "code": "28035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8831.16, "discounted_cash": 2124, "minimum": 609.34, "maximum": 8831.16, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4248.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2166.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3793.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7069.77, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2973.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 4035.62, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3929.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3186.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3186.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3823.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3292.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4061.74, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 609.34 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 906.36 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 906.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3398.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 615.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2124.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 2102.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5229, "maximum": 15300, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14052 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7265, "minimum": 3076, "maximum": 28598.148, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12932.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7410.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9445.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7265.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10898.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13441.25, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10898.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10898.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10898.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11261.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11624.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11908.95, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10753, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7265.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6007.98 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7192.88, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12100, "minimum": 3773, "maximum": 22386.0545, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21539.01, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12100.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12342.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12100.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15730.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12100.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 18150.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22386.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 18150.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18150.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18150.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12100.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12100.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18755.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19360.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19834.09, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12100.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17908.84, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12100.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12100.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16657 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11979.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13992, "minimum": 3773, "maximum": 31772.898, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24906.21, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13992.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14272.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13992.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18189.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13992.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 20988.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25885.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 20988.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20988.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 20988.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13992.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13992.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21687.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22387.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22934.78, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13992.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20708.53, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13992.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13992.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12897.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 13852.33, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15569, "minimum": 3773, "maximum": 66958.092, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27713.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15569.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15569.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20240.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 15569.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 23354.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 28803.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 23354.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23353.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 23354.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 15569.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15569.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24132.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24910.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 25519.64, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15569.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23042.62, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15569.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15569.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16662.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 15413.65, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9179, "minimum": 3744, "maximum": 23795, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16339.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9179.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9363.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9179.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11933.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9179.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13769.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16981.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13769.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13769.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13769.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9179.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9179.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14228.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14687.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15046.04, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9179.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13585.59, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9179.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9179.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4729.69 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9087.66, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9685, "minimum": 3773, "maximum": 17917.4535, "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9685.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9685.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8514.06 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9588.26, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17239.5, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9685.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9878.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9685.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12590.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9685.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 14527.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17917.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 14527.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14527.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14527.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9685.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9685.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15011.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15496.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15874.86, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9685.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14333.96, "additional_payer_notes": "148.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sod Phosphate Preservative Free Inj 10 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "63323050601", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.32, "10th_percentile": 4.2, "90th_percentile": 10.32, "count": "17" } ] } ] }, { "description": "Destruct lesion 15 or more", "code_information": [ { "code": "17111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000, "discounted_cash": 218, "minimum": 79.33, "maximum": 18000, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 389.76, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.13 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 726.38, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 414.64, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 403.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.81, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.73 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 338.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 417.32, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 682.14 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.33 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.13 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 216.05, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1048 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1055 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 10 Mg/Ml - 00641036721", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00641036721", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.32, "10th_percentile": 4.2, "90th_percentile": 10.32, "count": "17" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16508, "minimum": 3773, "maximum": 30540.133, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29384.56, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 16838.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21460.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 16508.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 24762.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 30540.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 24762.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24762.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 24762.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 16508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25587.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26413.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27058.59, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24432.11, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16508.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16508.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14699.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 16343.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 10 Mg/Ml - 00641036725", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00641036725", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.32, "10th_percentile": 4.2, "90th_percentile": 10.32, "count": "17" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 Mg/Ml - 63323016501", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "63323016501", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.32, "10th_percentile": 4.2, "90th_percentile": 10.32, "count": "17" } ] } ] }, { "description": "Dexamethasone Tab 0.75 Mg", "drug_information": { "unit": 100, "type": "EA" }, "code_information": [ { "code": "49884008501", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.56, "10th_percentile": 7.56, "90th_percentile": 18.84, "count": "1 through 10" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8210, "minimum": 3076, "maximum": 15188.759, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14614.05, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8374.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10673.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8210.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12315.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15188.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12315.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12315.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12315.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12725.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13136.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13457.24, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12151.01, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12846.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8128.04, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Dexamethasone Tab 0.5 Mg", "drug_information": { "unit": 100, "type": "EA" }, "code_information": [ { "code": "00054817925", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.56, "10th_percentile": 7.56, "90th_percentile": 18.84, "count": "1 through 10" } ] } ] }, { "description": "Dexamethasone Tab 4 Mg - 00054817525", "drug_information": { "unit": 100, "type": "EA" }, "code_information": [ { "code": "00054817525", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.56, "10th_percentile": 7.56, "90th_percentile": 18.84, "count": "1 through 10" } ] } ] }, { "description": "Cor hlx vlgs jt arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22000, "discounted_cash": 13964, "minimum": 1375, "maximum": 22000, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22000, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13964.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14244.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22000, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13964.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 22000, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19550.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13964.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22000, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22000, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20947.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20947.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22000, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13964.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13964.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21645.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22000, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13964.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 2764.37 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 4404.76 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 4404.76 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22000, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13964.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13964.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13964.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13825.21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3060 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2511 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Dexamethasone Tab 4 Mg - 00054418425", "drug_information": { "unit": 100, "type": "EA" }, "code_information": [ { "code": "00054418425", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.56, "10th_percentile": 7.56, "90th_percentile": 18.84, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 64392, "minimum": 3773, "maximum": 119125.903, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 114618.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 64392.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 65680.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 64392.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 83710.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 64392.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 96588.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 119125.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 96588.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 96588.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 96588.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 64392.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 64392.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 99808.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 103027.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 105545.58, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 64392.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 95300.72, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 64392.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 64392.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 80898.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 63748.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35927, "minimum": 3773, "maximum": 73530.198, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 63950.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35927.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 36645.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35927.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 46705.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 35927.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 53891.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 66465.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 53891.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 53891.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 53891.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 35927.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 35927.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 55687.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 57483.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 58888.6, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 35927.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 53172.51, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 35927.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35927.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50385.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 35568.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6546, "minimum": 3076, "maximum": 19953.864, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11652.91, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6677.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8510.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6546.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 9819.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12111.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 9819.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9819.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9819.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9000, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10147.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10474.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10730.5, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9688.94, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6546.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4727.63 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6481.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Create Eardrum Opening", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 1687, "minimum": 654.3311, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3375.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1721.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3014.2, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5617.44, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2362.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3206.59, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3122.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2531.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2531.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3037.82, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2615.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3227.35, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 707.5 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 654.33 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 654.33 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2700.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 714.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1687.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1670.8, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Diag Laparo Separate Proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21705.1, "discounted_cash": 6575, "minimum": 1375, "maximum": 21705.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13151.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6707.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11744.41, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1589.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 21705.1, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9206.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 12494.06, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12165.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9863.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9863.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11836.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1589.51 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10192.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12574.94, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1573.61 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 2469.15 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 2469.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10521.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1589.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1589.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6575.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 6510.06, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3569 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2899 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.2% - 00338007704", "drug_information": { "unit": 1000, "type": "ML" }, "code_information": [ { "code": "00338007704", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 18, "10th_percentile": 18, "90th_percentile": 18, "count": "1 through 10" } ] } ] }, { "description": "Diatrizoate Meglumine & Sodium Oral Soln 66-10% - 00270044540", "drug_information": { "unit": 120, "type": "ML" }, "code_information": [ { "code": "00270044540", "type": "NDC" }, { "code": "Q9963", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 174.06, "10th_percentile": 174.06, "90th_percentile": 174.06, "count": "1 through 10" } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.2% - 00990792409", "drug_information": { "unit": 1000, "type": "ML" }, "code_information": [ { "code": "00990792409", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 18, "10th_percentile": 18, "90th_percentile": 18, "count": "1 through 10" } ] } ] }, { "description": "Diphenhydramine Hcl Cap 25 Mg - 00904530661", "drug_information": { "unit": 100, "type": "EA" }, "code_information": [ { "code": "00904530661", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 4.2, "10th_percentile": 0.02, "90th_percentile": 4.2, "count": "1 through 10" } ] } ] }, { "description": "Diphenhydramine Hcl Inj 50 Mg/Ml - 00641037625", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00641037625", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.86, "10th_percentile": 0.93, "90th_percentile": 21.66, "count": "13" } ] } ] }, { "description": "Diphenhydramine Hcl Inj 50 Mg/Ml - 63323066401", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "63323066401", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.86, "10th_percentile": 0.93, "90th_percentile": 21.66, "count": "13" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14856, "minimum": 3773, "maximum": 27483.8775, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26443.95, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15153.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19313, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14856.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 22284.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27483.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 22284.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22284.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22284.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 21600, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23027.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23769.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24350.8, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21987.1, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16830.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14707.59, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Dicyclomine Hcl Inj 10 Mg/Ml", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "58914008052", "type": "NDC" }, { "code": "J0500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 13.21, "10th_percentile": 13.21, "90th_percentile": 174.54, "count": "1 through 10" } ] } ] }, { "description": "Diphenhydramine Hcl Liquid 12.5 Mg/5Ml - 00121048905", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "00121048905", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 4.2, "10th_percentile": 0.02, "90th_percentile": 4.2, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6548, "minimum": 3537, "maximum": 12114.2255, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11655.85, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6548.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6679.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6548.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8512.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6548.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 9822.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12114.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 9822.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9822.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6548.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6548.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10149.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10477.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10733.2, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6548.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9691.38, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6548.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6548.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5904.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6482.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11392, "minimum": 3773, "maximum": 21075.792, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 20278.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11620.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14810.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11392.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 17088.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 21075.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 17088.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17088.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 17088.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17658.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18227.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18673.12, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16860.63, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11392.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11830.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11278.4, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Diphenhydramine Hcl Tab 50 Mg", "drug_information": { "unit": 100, "type": "EA" }, "code_information": [ { "code": "00185064901", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 4.2, "10th_percentile": 0.02, "90th_percentile": 4.2, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10443, "minimum": 3773, "maximum": 19320.66, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 18589.61, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10443.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10652.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10443.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13576.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 10443.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 15665.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 19320.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 15665.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 15665.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15665.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 10443.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10443.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 16187.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16709.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 17118.1, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10443.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15456.53, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 10443.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10443.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9056.31 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 10339.16, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19043, "minimum": 3773, "maximum": 35231.178, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 33898.11, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19043.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 19424.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19043.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24757.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 19043.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 28565.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 35231.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 28565.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28565.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 28565.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 19043.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19043.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29518.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30470.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 31214.86, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19043.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28184.94, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19043.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19043.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22399 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 18853.44, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3691, "maximum": 10800, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9037.75 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8358, "minimum": 3773, "maximum": 15463.003, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14877.92, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8525.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10865.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8358.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12537.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15463, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12537.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12537.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12537.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12955.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13373.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13700.22, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12370.4, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8358.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7856.36 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8274.8, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Diphenhydramine Hcl Cap 25 Mg - 00904530660", "drug_information": { "unit": 100, "type": "EA" }, "code_information": [ { "code": "00904530660", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 4.2, "10th_percentile": 0.02, "90th_percentile": 4.2, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15191, "minimum": 3773, "maximum": 28103.9605, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27040.57, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15191.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15495.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15191.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19748.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 15191.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 22787, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 28103.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 22787, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22786.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22787, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 15191.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15191.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23546.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24306.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24900.06, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15191.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22483.17, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15191.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15191.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13804.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 15039.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Diphenhydramine Hcl Liquid 12.5 Mg/5Ml - 00603082358", "drug_information": { "unit": 473, "type": "ML" }, "code_information": [ { "code": "00603082358", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 4.2, "10th_percentile": 0.02, "90th_percentile": 4.2, "count": "1 through 10" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20562, "minimum": 3773, "maximum": 38040.6065, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 36601.23, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20562.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 20973.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20562.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26731.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 20562.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 30843.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 38040.61, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 30843.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 30843.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 30843.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 20562.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20562.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 31871.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32899.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 33703.99, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20562.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30432.49, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 20562.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20562.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24943.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 20356.87, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17624, "minimum": 3773, "maximum": 34503, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31370.88, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17624.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17976.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17624.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22911.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 17624.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 26436.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32604.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 26436.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26436.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26436.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 17624.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17624.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27317.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28198.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28887.66, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17624.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26083.65, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17624.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17624.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12637.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 17447.85, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8923, "minimum": 3773, "maximum": 37708.56, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15883.53, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9101.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11600.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8923.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13385, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16508.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13385, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13385, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13385, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13831.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14277.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14626.23, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13206.53, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8460.45 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8834.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11902, "minimum": 3773, "maximum": 22018.8665, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21185.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12140.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15472.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11902.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 17853.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22018.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 17853.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17853.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 17853.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18448.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19043.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19508.73, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17615.09, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12538.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11783.07, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8243, "minimum": 3384, "maximum": 15251.2335, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14674.16, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8243.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8408.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8243.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10717.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8243.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12365.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 15251.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12365.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12365.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8243.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8243.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12778.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13190.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13512.59, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8243.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12200.99, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8243.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8243.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6904.85 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8161.47, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Dx Lmbr Spi Pnxr", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10163.1, "discounted_cash": 767, "minimum": 256.04, "maximum": 10163.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1535.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 783.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1371.27, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 258.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2555.59, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1074.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1458.8, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1420.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1151.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1382.02, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 258.63 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1190.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1468.24, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1149.36 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 256.04 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 357.66 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 357.66 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1228.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 258.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 258.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 760.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1514 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1522 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9872, "minimum": 3773, "maximum": 18263.311, "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15301.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15795.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16181.29, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14610.65, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8462.52 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9773.34, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17572.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10069.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12833.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9872.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 14808.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18263.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 14808.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14808.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14808.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Destruct b9 lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000, "discounted_cash": 218, "minimum": 64.59, "maximum": 18000, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 389.76, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 726.38, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 414.64, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 403.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.81, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.54 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 338.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 417.32, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 563.09 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.24 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 216.05, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1048 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1055 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Dx Lmbr Spi Pnxr W/Fluor/Ct", "code_information": [ { "code": "62328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11650, "discounted_cash": 767, "minimum": 256.04, "maximum": 11650, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1535.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 783.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1371.27, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 258.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2555.59, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1074.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1458.8, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1420.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1151.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1382.02, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 258.63 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1190.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1468.24, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 681.88 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 256.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1228.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 258.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 258.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 760.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1514 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1522 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Dexamethasone Elixir 0.5 Mg/5Ml", "drug_information": { "unit": 237, "type": "ML" }, "code_information": [ { "code": "00603114756", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 7.56, "10th_percentile": 7.56, "90th_percentile": 18.84, "count": "1 through 10" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7620, "minimum": 2922, "maximum": 17662.068, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13564.45, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7620.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7772.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7620.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9906.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7620.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11430.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14097.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11430.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11430.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11430.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7620.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8550, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7620.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11811.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12192.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12490.73, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7620.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11278.31, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7620.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7620.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7917.18 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7544.28, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 Mg/Ml - 00517490125", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00517490125", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 10.32, "10th_percentile": 4.2, "90th_percentile": 10.32, "count": "17" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18868, "minimum": 3773, "maximum": 34906.651, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 33585.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18868.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 19245.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18868.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24529, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 18868.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 28302.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 34906.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 28302.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 28302.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 28302.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 18868.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18868.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 29246.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30189.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 30927.36, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18868.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27925.32, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 18868.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18868.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14694.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 18679.78, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 176229, "minimum": 3773, "maximum": 326025.1115, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 313689.03, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 176230, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 179754.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 176230, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 229098.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 176229.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 264344.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 326025.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 264344.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 264345, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 264344.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 176230, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 176230, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 273156.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 281967.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 288858.59, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 176230, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 260820.09, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 176230, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 176229.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 266529 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 174467.49, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Dextrose 5% W/ Sodium Chloride 0.45%", "drug_information": { "unit": 1000, "type": "ML" }, "code_information": [ { "code": "00338008504", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 18, "10th_percentile": 18, "90th_percentile": 18, "count": "1 through 10" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14987, "minimum": 3773, "maximum": 27726.1165, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26677.02, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14987.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15286.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14987.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19483.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14987.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 22480.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27726.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 22480.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22480.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22480.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14987.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14987.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 23229.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23979.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24565.36, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14987.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22180.89, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14987.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14987.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15283.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14837.22, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7758, "minimum": 3773, "maximum": 70238.916, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13809.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7913.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10085.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7758.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11637.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14352.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11637.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11637.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11637.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12024.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12412.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12716.17, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11481.87, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5309.04 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7680.44, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8811, "minimum": 3773, "maximum": 16300.9605, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15684.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8811.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8987.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8811.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11454.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8811.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13217, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16300.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13217, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13217, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13217, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8811.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 45000, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8811.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13657.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14098.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14442.65, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8811.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13040.77, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8811.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8811.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6528.58 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8723.22, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13262, "minimum": 3773, "maximum": 24535.7915, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23607.41, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13262.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13527.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13262.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17241.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13262.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 19893.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24535.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 19893.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19893.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19893.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13262.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13262.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20557.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21220.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21738.73, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13262.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19628.63, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13262.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13262.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11024.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 13129.96, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Exc Abd Les Sc 3 Cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 3159, "minimum": 618.84, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Diatrizoate Meglumine & Sodium Oral Soln 66-10% - 00270044535", "drug_information": { "unit": 30, "type": "ML" }, "code_information": [ { "code": "00270044535", "type": "NDC" }, { "code": "Q9963", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 174.06, "10th_percentile": 174.06, "90th_percentile": 174.06, "count": "1 through 10" } ] } ] }, { "description": "EXC ABDL TUM DEEP 5 CM>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11736.96, "discounted_cash": 3159, "minimum": 618.84, "maximum": 11736.96, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 } ] } ] }, { "description": "EXC FOREARM LES SC < 3 CM", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5037.1, "discounted_cash": 1796, "minimum": 618.84, "maximum": 5037.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5037.1, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12396, "minimum": 3773, "maximum": 22933.007, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 22065.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12644.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16115.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12396.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 18594.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22933.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 18594.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 18594.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18594.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19214.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19833.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 20318.61, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18346.41, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15815.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12272.26, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 1796, "minimum": 126.49, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5979.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.33 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1112.26 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.49 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 130.78 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 130.78 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.77 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1514 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1522 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7475, "minimum": 3384, "maximum": 23358.69, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13306.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7475.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7625.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7475.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9718.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7475.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11213.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13829.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11213.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11213.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11213.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7475.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7475.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11587.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11960.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12253.16, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7475.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11063.8, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7475.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7475.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5133.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7400.78, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9042, "minimum": 3537, "maximum": 16729.0875, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16096.1, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9042.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9223.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9042.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11755.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9042.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13564.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16729.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13564.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13564.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13564.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9042.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9042.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14016.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14468.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14821.97, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9042.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13383.27, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9042.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9042.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9157.34 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8952.32, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 1796, "minimum": 141.6399, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5979.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1149.36 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 412.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 141.64 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 141.64 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 416.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Exc Leg/Ankle Tum < 3 Cm", "code_information": [ { "code": "27618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 1796, "minimum": 618.84, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5979.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exc Neck Les Sc 3 Cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14671.2, "discounted_cash": 3159, "minimum": 618.84, "maximum": 14671.2, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Exc tr-ext b9+marg 0.6-1 cm", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000, "discounted_cash": 442, "minimum": 96.77, "maximum": 18000, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 884.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 451.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 789.72, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1471.76, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 619.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 840.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 663.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 795.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.71 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 685.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 845.56, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 865.54 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.77 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 118.24 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 118.24 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 707.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.75 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 442.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 437.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1048 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1055 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Diphenhydramine Hcl Liquid 12.5 Mg/5Ml - 00121048910", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00121048910", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 4.2, "10th_percentile": 0.02, "90th_percentile": 4.2, "count": "1 through 10" } ] } ] }, { "description": "Excision addl breast lesion", "code_information": [ { "code": "19126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7333.33, "minimum": 150.85, "maximum": 7333.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.37 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.42 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.85 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.37 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.37 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1048 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1055 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9380, "minimum": 3773, "maximum": 17353.74, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16697.11, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9568.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12194.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 14070.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17353.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 14070.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14070.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14070.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 14400, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14539.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15008.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15375.41, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13882.99, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9380.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9614.02 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9286.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7851, "minimum": 3773, "maximum": 14524.498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7851.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8008.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7851.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10206.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7851.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11776.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14524.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11776.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11776.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11776.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7851.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 4500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7851.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12169.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12561.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 12868.71, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7851.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11619.6, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7851.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7851.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6648.16 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7772.57, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 13974.92, "additional_payer_notes": "178.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 177261, "minimum": 3773, "maximum": 327934.145, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 315525.83, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 177262, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 180807.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 177262, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 230440.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 177261.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 265892.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 327934.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 265892.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 265893, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 265892.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 177262, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 177262, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 274755.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 283618.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 290550.14, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 177262, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 262347.32, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 177262, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 177261.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 271455 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 175489.08, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11875, "minimum": 3773, "maximum": 21970.119, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21138.82, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11875.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12113.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11875.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15438.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11875.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 17813.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 21970.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 17813.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17813.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 17813.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11875.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11875.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18407.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19001.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19465.46, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11875.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17576.1, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11875.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11875.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10676.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11756.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16210, "minimum": 3773, "maximum": 29990.128, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 28855.37, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16210.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 16535.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16210.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21074.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 16210.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 24316.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 29990.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 24316.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24316.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 24316.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 16210.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16210.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25126.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25937.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 26571.29, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16210.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23992.1, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16210.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16210.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18643.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 16048.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14793, "minimum": 2922, "maximum": 27368.086, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 26332.54, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14793.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15089.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14793.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19231.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14793.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 22190.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 27368.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 22190.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 22190.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22190.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14793.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8550, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14793.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22930.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23669.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 24248.19, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14793.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21894.47, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14793.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14793.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20655.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14645.62, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7193, "minimum": 3691, "maximum": 13307.161, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 12803.65, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7193.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 7336.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7193.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9350.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7193.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 10789.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 13307.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 10789.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 10789.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10789.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7193.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7193.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 11149.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11508.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 11790.14, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7193.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 10645.73, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7193.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7193.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6191.48 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7121.13, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "EXC ARMELBOW LES SC 3 CM>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18625.48, "discounted_cash": 3159, "minimum": 618.84, "maximum": 18625.48, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Fentanyl Citrate-Nacl 0.9% Iv Soln 2.5 Mg/250Ml", "drug_information": { "unit": 250, "type": "ML" }, "code_information": [ { "code": "09993408303", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.99, "10th_percentile": 0.99, "90th_percentile": 8.4, "count": "1 through 10" } ] } ] }, { "description": "EX ARMELBOW TUM DEEP < 5 CM", "code_information": [ { "code": "24076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2934.23, "discounted_cash": 3159, "minimum": 618.84, "maximum": 2934.23, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 2934.23, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exc Face Les Sbq 2 Cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 1796, "minimum": 618.84, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5979.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1149.36 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1514 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1522 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "EXC ARMELBOW LES SC < 3 CM", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3178.75, "discounted_cash": 1796, "minimum": 618.84, "maximum": 3178.75, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3178.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3178.75, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3178.75, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3178.75, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3178.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3178.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3178.75, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "EXC FACE TUM DEEP 2 CM>", "code_information": [ { "code": "21014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000, "discounted_cash": 3159, "minimum": 618.84, "maximum": 18000, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1149.36 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1514 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1522 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Exc Back Les Sc 3 Cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12715, "discounted_cash": 1796, "minimum": 618.84, "maximum": 12715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5979.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Exc Leg/Ankle Les Sc 3 Cm/>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 3159, "minimum": 618.84, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Exc legankle tum deep <5 cm", "code_information": [ { "code": "27619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000, "discounted_cash": 3159, "minimum": 618.84, "maximum": 18000, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 } ] } ] }, { "description": "EXC SHOULDER LES SC 3 CM>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18000, "discounted_cash": 1796, "minimum": 618.84, "maximum": 18000, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5979.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Exc Skn Hdrdnt Ax Smpl/Ntrm", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 3159, "minimum": 618.84, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7995, "minimum": 3230, "maximum": 14791.12, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14231.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7995.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8155.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7995.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10393.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7995.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14791.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11992.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7995.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7995.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12392.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12792.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13104.93, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7995.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11832.9, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7995.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7995.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9162.49 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7915.25, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Exc tr-ext mal+marg >4 cm", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5868.49, "discounted_cash": 1796, "minimum": 618.84, "maximum": 5868.49, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5868.49, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exc thighknee les sc 3 cm>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11934.24, "discounted_cash": 3159, "minimum": 618.84, "maximum": 11934.24, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21677, "minimum": 3773, "maximum": 40103.5045, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 38586.07, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21677.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 22111.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21677.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28180.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 21677.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 32516.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 40103.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 32516.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 32516.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 32516.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 21677.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21677.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 33600.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34684.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 35531.75, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21677.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32082.8, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 21677.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21677.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24504.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 21460.79, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13164, "minimum": 3773, "maximum": 24354.4915, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 23432.97, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13164.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13427.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13164.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17113.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13164.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 19746.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 24354.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 19746.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19746.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19746.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13164.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13164.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 20405.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21063.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21578.1, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13164.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19483.59, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13164.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13164.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13414.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 13032.94, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 2.1-3Cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 770, "minimum": 137.41, "maximum": 11737, "payers_information": [ { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1463.48, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1424.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1386.45, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.58 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1193.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1472.95, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1224.55 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.41 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 140.81 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 140.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1232.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.8 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1514 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1522 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 785.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1375.67, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2563.78, "additional_payer_notes": "332.85% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15546, "minimum": 3076, "maximum": 51220.296, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 27672.38, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15546.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 15857.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15546.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20210.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 15546.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 23319.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 28760.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 23319.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 23319.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 23319.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 15546.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15546.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 24096.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24874.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 25481.94, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15546.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23008.49, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 15546.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15546.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13092.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 15390.82, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35769, "minimum": 1697, "maximum": 66173.1125, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 63669.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35769.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 36484.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35769.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 46500.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 35769.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 53653.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 66173.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 53653.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 53653.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 53653.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 35769.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 35769.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 55442.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 57230.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 58629.46, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 35769.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 52938.49, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 35769.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35769.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47722.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 35411.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "per diem", "standard_charge_dollar": 1697 } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33501, "minimum": 3773, "maximum": 61977.2385, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 59632.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33501.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 34171.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 33501.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43551.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 33501.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 50251.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 61977.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 50251.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 50251.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 50251.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 33501.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33501.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 51926.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 53601.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 54911.82, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 33501.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49581.79, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 33501.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33501.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49512.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 33166.2, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Famotidine Inj 20 Mg/2Ml", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "63323073912", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6.48, "10th_percentile": 0.8, "90th_percentile": 12.96, "count": "1 through 10" } ] } ] }, { "description": "Fusion of foot bones - 28735 - ", "code_information": [ { "code": "28735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6846.55, "discounted_cash": 13964, "minimum": 1642, "maximum": 6846.55, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 6171.38 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 6846.55 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 6846.55 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6233.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 6846.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4661 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3303 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28542, "minimum": 3773, "maximum": 52803.884, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 50805.9, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28542.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 29113.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28542.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 37105.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 28542.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 42813.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 52803.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 42813.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 42813.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 42813.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 28542.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 28542.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 44241.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 45668.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 46784.18, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 28542.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 42243.11, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 28542.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28542.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46978.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 28257.21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51900, "minimum": 3773, "maximum": 96016.5725, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 92383.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 52938.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 51900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 67471.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 51900.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 77851.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 96016.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 77851.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 77851.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 77851.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 51900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 51900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 80446.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 83041.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 85070.6, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 51900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 76813.26, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 51900.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51900.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43302.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 51381.84, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (Pf) Inj 100 Mcg/2Ml - 00409909332", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "00409909332", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.99, "10th_percentile": 0.99, "90th_percentile": 8.4, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16485, "minimum": 3773, "maximum": 30497.472, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29343.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 16814.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21430.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 16485.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 24727.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 30497.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 24727.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24727.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 24727.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25551.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26376.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27020.73, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24397.98, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16485.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17464.2 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 16320.27, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11111, "minimum": 1846, "maximum": 20556.2565, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 19778.45, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11111.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 11333.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11111.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14444.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11111.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 16667.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 20556.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 16667.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 16667.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16667.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11111.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11111.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 17222.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17778.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 18212.86, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11111.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16445.01, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11111.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11111.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16877.6 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11000.38, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40638, "minimum": 1999, "maximum": 102755.826, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 72335.73, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 41450.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 40638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 52829.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 40638.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 60957.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 75180.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 60957.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 60957.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 60957.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 40638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 40638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 62988.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 65020.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 66609.91, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 40638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 60144.31, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 40638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40638.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4171.98 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 40231.67, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Fentanyl Infusion 1000 Mcg In Ns", "drug_information": { "unit": 100, "type": "ML" }, "code_information": [ { "code": "52533002475", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.99, "10th_percentile": 0.99, "90th_percentile": 8.4, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6622, "minimum": 3076, "maximum": 12251.3475, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 11787.78, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6754.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8609.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 6622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 9933.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 12251.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 9933.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 9933.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9933.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 6622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9000, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 10264.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10595.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 10854.69, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 9801.08, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 6622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7033.72 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 6556.13, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (Pf) Inj 100 Mcg/2Ml - 00409909422", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "00409909422", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.99, "10th_percentile": 0.99, "90th_percentile": 8.4, "count": "1 through 10" } ] } ] }, { "description": "Fentanyl Infusion 2500 Mcg In Ns", "drug_information": { "unit": 250, "type": "ML" }, "code_information": [ { "code": "09993408303", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.99, "10th_percentile": 0.99, "90th_percentile": 8.4, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7935, "minimum": 3773, "maximum": 14679.898, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14124.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7935.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8093.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7935.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10315.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 7935.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 11902.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14679.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 11902.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11902.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 7935.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7935.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12299.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12696.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13006.39, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7935.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11743.92, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 7935.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7935.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5953.35 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7855.73, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Fentanyl Citrate-Nacl 0.9% Iv Soln 1 Mg/100Ml (10 Mcg/Ml)", "drug_information": { "unit": 100, "type": "ML" }, "code_information": [ { "code": "52533002475", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.99, "10th_percentile": 0.99, "90th_percentile": 8.4, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13592, "minimum": 3773, "maximum": 25146.7355, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13592.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17670.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 13592.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 20389.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 25146.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 20389.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 20389.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 20389.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 13592.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13592.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21068.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21748.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 22279.96, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13592.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20117.39, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 13592.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13592.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12899.4 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 13456.9, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 24195.24, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13592.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13864.66, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Car Outp Meas Drg Car Cath Eval Cgen Hrt Defect", "code_information": [ { "code": "93598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 888, "minimum": 63.76, "maximum": 888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 888 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.4 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 888 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.69 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.76 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.4 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 888 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 888 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 888 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 888 } ] } ] }, { "description": "Hc R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj", "code_information": [ { "code": "93596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14807.6, "discounted_cash": 3526, "minimum": 290.03, "maximum": 14807.6, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7052.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6487 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3596.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6297.97, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11737.29, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4936.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6699.97, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6523.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5289.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5289.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6347.34, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 298.82 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5465.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6743.34, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.03 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 292.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3526.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3491.04, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3569 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2899 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc Vnpnxr 3 Years/> Phys/Qhp Skill", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.35, "minimum": 9.17, "maximum": 244.35, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.72 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.98 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.72 } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16824, "minimum": 3773, "maximum": 31125.177, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 29947.47, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16824.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16824.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21871.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 16824.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 25236.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 31125.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 25236.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 25236.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25236.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 16824.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16824.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 26077.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26919.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 27576.87, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16824.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24900.14, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16824.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16824.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19621.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 16656.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24416, "minimum": 3773, "maximum": 45170.858, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 43461.69, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 24905.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 31741.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 24416.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 36625.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 45170.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 36625.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 36625.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 36625.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 24416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 37845.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 39066.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 40021.41, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 24416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36136.69, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 24416.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24416.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30284.3 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 24172.51, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8069, "minimum": 3773, "maximum": 19153.08, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14363.39, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8230.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10490.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8069.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12103.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14928.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12103.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12103.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12103.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12507.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12910.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13226.42, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11942.59, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8069.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5352.34 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 7988.63, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8081, "minimum": 3773, "maximum": 14951.0895, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 14385.37, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8081.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8243.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8081.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10506.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8081.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 12122.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 14951.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 12122.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 12122.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12122.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8081.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8081.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 12526.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12930.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 13246.67, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8081.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 11960.87, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8081.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8081.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6569.82 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8000.85, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Fusion of foot bones - 28725 - ", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5595.77, "discounted_cash": 13964, "minimum": 1642, "maximum": 5595.77, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 2764.37 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 5595.77 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 5595.77 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5595.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4661 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3303 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60501, "minimum": 3773, "maximum": 111927.0905, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 107692.01, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 60501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 61711.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 60501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 78651.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 60501.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 90751.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 111927.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 90751.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 90751.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 90751.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 60501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 60501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 93776.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 96801.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 99167.35, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 60501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 89541.67, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 60501.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60501.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35466.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 59896.12, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Fusion of foot bones - 28730 - ", "code_information": [ { "code": "28730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9166.66, "discounted_cash": 13964, "minimum": 1642, "maximum": 9166.66, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 2764.37 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 9128.05 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 9128.05 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2792.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 9166.66, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4661 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3303 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27955, "minimum": 3773, "maximum": 58179.348, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 49760.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27955.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 28514.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27955.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 36342.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 27955.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 41933.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 51717.6, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 41933.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 41933.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 41933.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 27955.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 27955.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 43330.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 44728.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 45821.86, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27955.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 41374.08, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 27955.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27955.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17961.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 27675.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Gadoterate Meglumine Iv Soln 10 Mmol/20Ml (0.5 Mmol/Ml)", "drug_information": { "unit": 15, "type": "ML" }, "code_information": [ { "code": "00407294302", "type": "NDC" }, { "code": "A9575", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 359.17, "10th_percentile": 234.83, "90th_percentile": 540, "count": "1 through 10" } ] } ] }, { "description": "Gadoterate Meglumine Iv Soln 7.5 Mmol/15Ml (0.5 Mmol/Ml)", "drug_information": { "unit": 15, "type": "ML" }, "code_information": [ { "code": "00407294302", "type": "NDC" }, { "code": "A9575", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 359.17, "10th_percentile": 234.83, "90th_percentile": 540, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5910, "minimum": 3537, "maximum": 10934.98, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 10521.22, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 6029.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7684.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 5910.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 8866.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 10934.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 8866.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 8866.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 9161.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9457.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 9688.39, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8747.98, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4412.17 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 5851.69, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Glycopyrrolate Inj 0.4 Mg/2Ml (0.2 Mg/Ml) - 00143968201", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00143968201", "type": "NDC" }, { "code": "J1596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 2.58, "count": "1 through 10" } ] } ] }, { "description": "Haloperidol Lactate Inj 5 Mg/Ml - 25021080601", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "25021080601", "type": "NDC" }, { "code": "J1630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 8.64, "10th_percentile": 8.64, "90th_percentile": 8.64, "count": "1 through 10" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14395, "minimum": 3773, "maximum": 26632.2115, "payers_information": [ { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 21593.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21593.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21593.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22313.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23033.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23596.16, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21305.77, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14395.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16019.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14251.83, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25624.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14683.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14395.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18714.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14395.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 21593.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26632.21, "additional_payer_notes": "185.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9849, "minimum": 3691, "maximum": 47612.286, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 17532.68, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9849.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 10046.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9849.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12804.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9849.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 14774.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 18222.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 14774.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14774.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14774.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9849.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9849.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 15267.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15759.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 16144.84, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9849.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14577.73, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9849.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9849.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10039.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9751.32, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "EXC BACK LES SC < 3 CM", "code_information": [ { "code": "21930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5868.49, "discounted_cash": 1796, "minimum": 618.84, "maximum": 5868.49, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5868.49, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17607, "minimum": 3773, "maximum": 57359.142, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 31341.55, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 17959.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22889.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 17607.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 26411.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 32574.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 26411.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 26411.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26411.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 27291.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28172.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 28860.62, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 26059.26, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17607.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19193 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 17431.53, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "EXC FOREARM LES SC 3 CM>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5501.7, "discounted_cash": 1796, "minimum": 618.84, "maximum": 5501.7, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5501.7, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Hc Myocardial Perfusion Planar 1 Study Rest/Stress", "code_information": [ { "code": "78453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6673.1, "discounted_cash": 1408, "minimum": 274.31, "maximum": 6673.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2816.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1436.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2515.06, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4687.23, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1971.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 2675.6, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2605.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2112.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2112.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2534.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 282.62 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2182.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2692.92, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.31 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2253.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.08 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1408.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1394.13, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 983.5 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 983.5 } ] } ] }, { "description": "Exc Shoulder Tum Deep 5 Cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14671.2, "discounted_cash": 3159, "minimum": 618.84, "maximum": 14671.2, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6319, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3222.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5642.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10516.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2138.71 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4423.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6003.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5845.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5687.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4897.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6041.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2174.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1250.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5055.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2130.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3127.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 2196.46 } ] } ] }, { "description": "Exc Tr-Ext B9+Marg >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14802.7, "discounted_cash": 1796, "minimum": 618.84, "maximum": 14802.7, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3592.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3208.48, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5979.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3413.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3323.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2694.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3233.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2784.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3435.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 618.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 634.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2874.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 625.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1796.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1778.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 1.1-2 Cm", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11737, "discounted_cash": 770, "minimum": 106.65, "maximum": 11737, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 785.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1375.67, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2563.78, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1463.48, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1424.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1386.45, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.88 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1193.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1472.95, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 946.3 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.65 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 129.52 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 129.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1232.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1514 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1522 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Excise intrspinl lesion thrc", "code_information": [ { "code": "63266", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3617.52, "discounted_cash": 7892, "minimum": 1085.256, "maximum": 3617.52, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1862 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1649.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1682.4 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3617.52 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1632.92 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1649.41 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1649.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3617.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3617.52 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3303 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Excision breast lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14666.67, "discounted_cash": 4258, "minimum": 957.37, "maximum": 14666.67, "payers_information": [ { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 957.37 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1226.06 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1226.06 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6814.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1724.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 4216.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1778.08 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8517.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1375 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4344.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7606.36, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14175.68, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1731.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5962.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 8091.87, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7878.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6388.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7665.98, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 967.04 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4258.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6601.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 8144.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1760.3 } ] } ] }, { "description": "Expl Pentrg Wnd Abd/Flnk/Bk", "code_information": [ { "code": "20102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18470.1, "discounted_cash": 2244, "minimum": 588.975, "maximum": 18470.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4488.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2240 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4008.25, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7470.02, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 4264.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4151.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4039.67, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3478.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4291.7, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1149.36 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 617.49 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3590.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 2221.82, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40069, "minimum": 3773, "maximum": 74129.13, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 71324.24, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40069.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 40871.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 40069.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 52090.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 40069.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 60104.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 74129.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 60104.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 60104.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 60104.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 40069.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 40069.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 62108.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 64111.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 65678.41, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 40069.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 59303.3, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 40069.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40069.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57706.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 39669.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14071, "minimum": 3773, "maximum": 26031.9235, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25046.93, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14352.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18292.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14071.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 21106.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26031.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 21106.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21106.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21106.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 21810.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22514.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23064.27, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20825.54, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24004.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 13930.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50378, "minimum": 2482, "maximum": 93199.522, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 89673.05, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 50378.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 51385.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 50378.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 65491.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 50378.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 75567.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 93199.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 75567.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 75567.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 75567.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 50378.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50378.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 78086.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 80604.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 82574.74, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 50378.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 74559.62, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 50378.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50378.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7571.84 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 49874.34, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "per diem", "standard_charge_dollar": 2482 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12855, "minimum": 2153, "maximum": 38359.944, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 22883.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12855.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 13112.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12855.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16712.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 12855.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 19283.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 23783.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 19283.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 19283.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19283.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 12855.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12855.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 19926.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20569.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 21071.94, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12855.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19026.52, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 12855.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12855.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19878.5 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 12727.2, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8741, "minimum": 3773, "maximum": 22384.602, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15559.57, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8741.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8916.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8741.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11363.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8741.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13112, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16171.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13112, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13112, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13112, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8741.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8741.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13549.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13986.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14327.91, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8741.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12937.17, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8741.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8741.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6511.06 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8653.92, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16195, "minimum": 3773, "maximum": 29961.1755, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 28827.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16195.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 16519.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16195.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21053.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 16195.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 24292.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 29961.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 24292.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 24292.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 24292.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 16195.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16195.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 25102.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25912.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 26545.55, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16195.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23968.94, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 16195.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16195.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14780.8 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 16033.28, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8805, "minimum": 3773, "maximum": 23061.384, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 15673.91, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8805.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 8981.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8805.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11447.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 8805.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 13208.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 16290.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 13208.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 13208.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13208.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 8805.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8805.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 13648.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14088.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 14433.21, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8805.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13032.24, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 8805.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8805.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7582.14 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 8717.51, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14341, "minimum": 3773, "maximum": 26531.6455, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 25527.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14341.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 14628.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14341.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18643.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 14341.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 21512.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 26531.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 21512.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 21512.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21512.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 14341.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14341.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 22229.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22946.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 23506.99, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14341.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21225.32, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 14341.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14341.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17448.7 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 14198.02, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11988, "minimum": 3773, "maximum": 22178.8545, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 21339.65, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11988.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 12228.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11988.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15585.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 11988.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 17982.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 22178.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 17982.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 17982.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 17982.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 11988.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11988.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 18582.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19181.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 19650.51, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11988.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17743.08, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 11988.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11988.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15217.9 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 11868.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19636, "minimum": 3752.42, "maximum": 36326.6185, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 34952.1, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19636, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 20028.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19636, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25526.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 19636.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 29454.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 36326.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 29454.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 29454, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 29454.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 19636, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19636, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 30435.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 31417.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 32185.37, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19636, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29061.29, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 19636, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19636.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3752.42 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 19439.65, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9507, "minimum": 3773, "maximum": 17588.3755, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "case rate", "standard_charge_dollar": 16922.87, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "case rate", "standard_charge_dollar": 9697.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12359.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "case rate", "standard_charge_dollar": 9507.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "case rate", "standard_charge_dollar": 14260.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "case rate", "standard_charge_dollar": 17588.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "case rate", "standard_charge_dollar": 14260.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "case rate", "standard_charge_dollar": 14260.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14260.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "case rate", "standard_charge_dollar": 14736.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15211.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "case rate", "standard_charge_dollar": 15583.3, "additional_payer_notes": "163.91% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14070.7, "additional_payer_notes": "148.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9016.1 }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "case rate", "standard_charge_dollar": 9412.16, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 3773 } ] } ] }, { "description": "Glycopyrrolate Inj 0.4 Mg/2Ml (0.2 Mg/Ml) - 00517460125", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00517460125", "type": "NDC" }, { "code": "J1596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.72, "10th_percentile": 1.72, "90th_percentile": 2.58, "count": "1 through 10" } ] } ] }, { "description": "Haloperidol Lactate Inj 5 Mg/Ml - 63323047401", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "63323047401", "type": "NDC" }, { "code": "J1630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 8.64, "10th_percentile": 8.64, "90th_percentile": 8.64, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4215) Sterile Needle", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 0.25, "10th_percentile": 0.25, "90th_percentile": 43.41, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - 27200146", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6402) Sterile Gauze <= 16 Sq In - A6402 - 27200152", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 3.6, "10th_percentile": 3.6, "90th_percentile": 3.6, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6402) Sterile Gauze <= 16 Sq In - A6402 - RU272059", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 3.6, "10th_percentile": 3.6, "90th_percentile": 3.6, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6448) Lt Compres Band <3/Yd - A6448 - 27090038", "code_information": [ { "code": "A6448", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.27, "10th_percentile": 1.27, "90th_percentile": 1.27, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - RU272058", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 1.68, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6448) Lt Compres Band <3/Yd - A6448 - 27100024", "code_information": [ { "code": "A6448", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1.27, "10th_percentile": 1.27, "90th_percentile": 1.27, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1713) Anchr/Screw Oppos Bn-Bn/Sft Tiss-Bn", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 28.47, "median_amount": 40717.71, "10th_percentile": 40717.71, "90th_percentile": 40717.71, "count": "1 through 10" }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 35, "median_amount": 5600, "10th_percentile": 5600, "90th_percentile": 5600, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1729) Catheter Drainage", "code_information": [ { "code": "C1729", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 506.92, "10th_percentile": 506.92, "90th_percentile": 506.92, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1755) Catheter Intraspinal", "code_information": [ { "code": "C1755", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 664.58, "10th_percentile": 664.58, "90th_percentile": 1701.89, "count": "1 through 10" } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14093.9, "discounted_cash": 8483, "minimum": 533.02, "maximum": 14093.9, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14093.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2642 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8653.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14093.9, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.4 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14093.9, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11877.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 14093.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14093.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12725.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12725.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14093.9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.17 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13149.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14093.9, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 533.02 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13574.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.4 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8483.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 8398.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 4661 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 9097 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc Acne Surgery Of Skin Abscess", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.49, "discounted_cash": 218, "minimum": 82.04, "maximum": 353.49, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.49, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 353.49, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.87 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 353.49, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 353.49, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.49, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.53 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 338.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 353.49, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 353.49 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.87 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 216.05, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 353.49 } ] } ] }, { "description": "Hc Acth Stimj Panel 3 Beta-Hydroxydehyd Defncy", "code_information": [ { "code": "80406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1073.5, "discounted_cash": 78, "minimum": 52.17, "maximum": 1073.5, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 148.69, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.87, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.45 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 149.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 125.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.38 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 77.48, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 52.17 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.17 } ] } ] }, { "description": "Hc Acth Stimulation Panel 21 Hydroxylase Deficiency", "code_information": [ { "code": "80402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.8, "discounted_cash": 86, "minimum": 57.97, "maximum": 1192.8, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 165.22, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 130.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.53, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.51 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 134.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 166.29, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.32 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 86.09, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 57.97 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.97 } ] } ] }, { "description": "Hc Acylcarnitines Quant", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.33, "discounted_cash": 16, "minimum": 11.24, "maximum": 304.33, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 32.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.24 } ] } ] }, { "description": "Hc Adjacent Tissue Trns/Reargmt F/C/C/M/N/A/G/H/F 10Sqcm/&Lt", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2713.26, "discounted_cash": 2244, "minimum": 617.49, "maximum": 14470.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health", "methodology": "fee schedule", "standard_charge_dollar": 1034.22 }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 617.49 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 925.17 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 925.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 2221.82, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Hc Ag Detection Polyval If", "code_information": [ { "code": "87300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.86, "discounted_cash": 11, "minimum": 7.99, "maximum": 186.86, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.99 } ] } ] }, { "description": "Hc Agglutinins; Febrile", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.95, "discounted_cash": 6, "minimum": 4.66, "maximum": 90.95, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.86 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 6.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.66 } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180, "discounted_cash": 14, "minimum": 9.64, "maximum": 180, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 27.47, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.03, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.07 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.65, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.64 } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167, "discounted_cash": 13, "minimum": 8.96, "maximum": 167, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 492.43, "discounted_cash": 64, "minimum": 25.1, "maximum": 492.43, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 122.38, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.86 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 123.17, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 103.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.94 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.94 } ] } ] }, { "description": "Hc Amino Acids, Multiple Qual", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.68, "discounted_cash": 13, "minimum": 9.25, "maximum": 245.68, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.25 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.25 } ] } ] }, { "description": "Hc Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3381.47, "discounted_cash": 3559, "minimum": 636.77, "maximum": 3381.47, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 636.77 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3381.47, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Hc Amputation Toe Interphalangeal Joint", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13116.7, "discounted_cash": 3559, "minimum": 636.77, "maximum": 16980, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7118.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3630.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6356.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11846.16, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4982.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6762.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6584.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5338.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6406.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5516.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6805.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 636.77 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1457.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5694.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 643.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3559.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3523.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 2331 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2191 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 } ] } ] }, { "description": "Hc Anesth Vag Delivery, Epidural", "code_information": [ { "code": "01967", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1151.33, "minimum": 345.399, "maximum": 1151.33, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.94 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 545.64 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 529.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.94 } ] } ] }, { "description": "Hc Angio Adrenal Unilat Select", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4234.33, "discounted_cash": 3434, "minimum": 131.34, "maximum": 4234.33, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.32 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.67 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 874.9 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 874.9 } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16401.3, "discounted_cash": 3434, "minimum": 100.65, "maximum": 16401.3, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6133.91, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11431.53, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6525.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6181.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.72 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5323.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6567.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.08 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5495.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5633.71, "discounted_cash": 6052, "minimum": 108.57, "maximum": 5633.71, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.43 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.01 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3501.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3501.22 } ] } ] }, { "description": "Hc Anoscopy W Biopsy Sing/Mult", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1661.03, "discounted_cash": 1301, "minimum": 73.05, "maximum": 1661.03, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1327.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.79 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1661.03 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.27 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 609.08 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.05 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 229.38 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 229.38 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1661.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.79 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1661.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1288.58, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1661.03 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1661.03 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1661.03 } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229, "discounted_cash": 8, "minimum": 5.77, "maximum": 229, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 16.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 4.79, "10th_percentile": 4.79, "90th_percentile": 4.79, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 137.4, "10th_percentile": 5.84, "90th_percentile": 137.4, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.77 } ] } ] }, { "description": "Hc Antibody Hla Class Ii High Definition Panel Qual", "code_information": [ { "code": "86833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 846, "discounted_cash": 325, "minimum": 195.48, "maximum": 846, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 651.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 332.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 456.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 619.02, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 602.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 488.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 488.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.44, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 504.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 623.03, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 521.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 322.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 195.48 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.48 } ] } ] }, { "description": "Hc Antibody Hla Class Ii Phenotype Panel Qual", "code_information": [ { "code": "86831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605, "discounted_cash": 81, "minimum": 49.13, "maximum": 605, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 155.57, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.38, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 126.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 156.58, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 131.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 81.06, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 49.13 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.13 } ] } ] }, { "description": "Hc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511, "discounted_cash": 185, "minimum": 3.45, "maximum": 918.45, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.96, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 511, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 352.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 287.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 354.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.49 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 183.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.45 } ] } ] }, { "description": "Hc Antinomyces Antibody", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82, "discounted_cash": 10, "minimum": 6.79, "maximum": 82, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.79 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.79 } ] } ] }, { "description": "Hc Antinuclear Antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 681.25, "discounted_cash": 12, "minimum": 8.06, "maximum": 681.25, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.76, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.42 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.12, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.06 } ] } ] }, { "description": "Hc Antithrombin Iii Test,Antigen", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.65, "discounted_cash": 10, "minimum": 7.21, "maximum": 73.65, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.46, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.21 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.21 } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9531.93, "discounted_cash": 803, "minimum": 617.49, "maximum": 9531.93, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1607.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 819.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1435.77, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2675.78, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1527.41, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1487.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1447.02, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1246.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1537.3, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 749.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 617.49 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 925.17 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 925.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1286.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 795.86, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9531.93, "discounted_cash": 803, "minimum": 617.49, "maximum": 9531.93, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1607.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 819.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1435.77, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2675.78, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1125.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1527.41, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1487.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1205.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1447.02, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1246.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1537.3, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 674.28 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 617.49 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 925.17 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 925.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1286.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 623.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 795.86, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc Appl Multlay Comprs Arm/Hand", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.5, "discounted_cash": 176, "minimum": 80.4087, "maximum": 560.5, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 560.5, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.63 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 335.83, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.15, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 273.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 338, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.36 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 80.41 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 80.41 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 174.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 560.5 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 560.5 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.63 } ] } ] }, { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.69, "discounted_cash": 144, "minimum": 37.32, "maximum": 671.69, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.47, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 481.7, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 274.97, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.45 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 276.75, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 329.79 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.32 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 231.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 143.27, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 671.69 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 671.69 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.12 } ] } ] }, { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.24, "discounted_cash": 176, "minimum": 55.96, "maximum": 205.24, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.24 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.96 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 59.33 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 59.33 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 174.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 205.24 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 205.24 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.24 } ] } ] }, { "description": "Hc Apply/Remove Cranial Fix Dev", "code_information": [ { "code": "20660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5714.24, "discounted_cash": 1749, "minimum": 479.76, "maximum": 5714.24, "payers_information": [ { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3323.18, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3235.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2623.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2623.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3148.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2711.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3344.69, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1539.4 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 479.76 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2798.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1508.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1731.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1554.95 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3498.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1784.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3123.79, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 484.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1749.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5714.24, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1514.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2448.66, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.82, "discounted_cash": 64, "minimum": 3.59, "maximum": 167.82, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 121.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.49, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 122.69, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.59 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.59 } ] } ] }, { "description": "Hc Arc Blood Typing, Rh Phenotype", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 40, "minimum": 5.17, "maximum": 200, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 77.18, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 77.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.24 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 40.21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.17 } ] } ] }, { "description": "Hc Arc Cold Agglutinin Screen", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.64, "discounted_cash": 8, "minimum": 4.52, "maximum": 113.64, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 15.43, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.84 } ] } ] }, { "description": "Hc Arc Frozen Blood,Freezing", "code_information": [ { "code": "86930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 427.38, "discounted_cash": 185, "minimum": 58.96, "maximum": 427.38, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.96, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 427.38, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 352.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.75 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 287.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 354.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 183.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 164.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.53 } ] } ] }, { "description": "Hc Arc Hemolysins/Agglutinins Auto", "code_information": [ { "code": "86940", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172, "discounted_cash": 8, "minimum": 5.47, "maximum": 172, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 16.66, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.71 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.47 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.47 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Chem Or Drugs", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.4, "discounted_cash": 64, "minimum": 14.69, "maximum": 177.4, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.59, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.4, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 121.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.49, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 122.69, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.27 } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1544, "discounted_cash": 333, "minimum": 55.81, "maximum": 1544, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 596.31, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1111.32, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1544 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 467.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 634.37, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.98, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.5 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 517.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 638.48, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 474.9 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.81 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 56.83 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 56.83 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.37 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1544 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 330.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1048 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1055 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1544 } ] } ] }, { "description": "Hc Ashkenazi Jewish Assoc Dsrdrs Gen Seq Anal 9 Gen", "code_information": [ { "code": "81412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2448.56, "discounted_cash": 2448, "minimum": 734.568, "maximum": 2448.56, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2448.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2448.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 2424.07, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1469.14 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 1469.14 } ] } ] }, { "description": "Hc Aspergillus Ag Eia", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247, "discounted_cash": 11, "minimum": 7.99, "maximum": 247, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.99 } ] } ] }, { "description": "Hc Ablate/ Reconstuct Atria, W Othr Proced Limitd", "code_information": [ { "code": "33257", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.79, "minimum": 160.437, "maximum": 534.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 534.79 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 534.79 } ] } ] }, { "description": "Hc Aspiration And/Or Injection Thyroid Cyst", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1003, "discounted_cash": 770, "minimum": 91.5048, "maximum": 1003, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1003 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 225.36 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 91.5 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 91.5 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 227.64 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1003 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 227.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 762.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1003 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1003 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1003 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 785.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 227.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1003 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 227.64 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 770.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Blckg Antb", "code_information": [ { "code": "86042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 18, "minimum": 9.11, "maximum": 92, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 18.22, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.04 } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - C8923 - 48300011", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1501, "discounted_cash": 852, "minimum": 450.3, "maximum": 1501, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1501, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 869.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1501, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1501, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1193.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1501, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1501, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1279.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1279.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1501, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1321.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1501, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1364.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 852.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 844.15, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 696 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 702 } ] } ] }, { "description": "Hc Assay Alkal Phosphatase,Heat Stabl W/O Total", "code_information": [ { "code": "84078", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.83, "discounted_cash": 8, "minimum": 4.52, "maximum": 146.83, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 8.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.96 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.96 } ] } ] }, { "description": "Hc Actin Smooth Muscle Antibody Each", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.25, "discounted_cash": 12, "minimum": 5.7, "maximum": 60.25, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.88 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.76 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.92 } ] } ] }, { "description": "Hc 3D Rendering W/Interp&Postproc Diff Work Statio", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1015.03, "minimum": 46.04, "maximum": 1015.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 585 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.43 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.5 } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase ,Isoenzymes", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.4, "discounted_cash": 14, "minimum": 9.86, "maximum": 161.4, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 28.08, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 28.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.99 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.86 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.86 } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1292.37, "discounted_cash": 986, "minimum": 69.43, "maximum": 1292.37, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1006.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1292.37 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.53 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.05 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 454.86 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 454.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1292.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1292.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 976.67, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1292.37 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1292.37 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1292.37 } ] } ] }, { "description": "Hc Assay Anti-Mullerian Horm", "code_information": [ { "code": "82166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.1, "discounted_cash": 38, "minimum": 23.17, "maximum": 193.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 73.38, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.52, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 73.85, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 38.23, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23.17 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.17 } ] } ] }, { "description": "Hc Admin Influenza Virus Vac - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.43, "discounted_cash": 50, "minimum": 50.4207, "maximum": 240.43, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.96, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 96.77, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.67, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 97.39, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 50.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 62 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 62 } ] } ] }, { "description": "Hc Abl1 Gene Analysis Kinase Domain Variants", "code_information": [ { "code": "81170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 300, "minimum": 180, "maximum": 962.28, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 570, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 555, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 540, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 465, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 573.69, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 297, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 180 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 180 } ] } ] }, { "description": "Hc Assay Biovlbl Testosterone Direct Measurement", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.6, "discounted_cash": 51, "minimum": 34.19, "maximum": 316.6, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 97.43, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.3, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 79.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 98.06, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 50.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 34.19 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.19 } ] } ] }, { "description": "Hc Aep Scr Auditory Potential W/Stimuli Auto Alys", "code_information": [ { "code": "92650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.6, "minimum": 25.26, "maximum": 273.6, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.52 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.26 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.52 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 252 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 255 } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - 93307 - 48300011", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1501, "discounted_cash": 259, "minimum": 76.98, "maximum": 1501, "payers_information": [ { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 389.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 389.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 467.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.32 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 402.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 496.28, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.98 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 415.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.76 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 256.92, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 696 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 702 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 519.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 264.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 863.81, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 363.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 259.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 493.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 480.11, "additional_payer_notes": "185.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acoustic Immitance Testing", "code_information": [ { "code": "92570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.6, "discounted_cash": 139, "minimum": 26.19, "maximum": 265.6, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 249.95, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 265.6, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 265.6, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.98 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 216.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 265.6, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.19 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 223.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 138.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 252 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 255 } ] } ] }, { "description": "Hc Assay For Phencyclidine", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.05, "discounted_cash": 20, "minimum": 1, "maximum": 157.05, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.72, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 38, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.95 } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 700, "discounted_cash": 238, "minimum": 16.24, "maximum": 700, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 425.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 700, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 452.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.72, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 369.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 455.47, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 280, "10th_percentile": 280, "90th_percentile": 280, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 420, "10th_percentile": 16.24, "90th_percentile": 420, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 235.8, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 252 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 255 } ] } ] }, { "description": "Hc 3D Rendering W/Interp & Postprocess Supervision (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860, "minimum": 19.85, "maximum": 860, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 585 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.85 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05 } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348, "discounted_cash": 15, "minimum": 10.22, "maximum": 348, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 29.11, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.22 } ] } ] }, { "description": "Hc Assay Galactose Transferase", "code_information": [ { "code": "82775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.61, "discounted_cash": 21, "minimum": 14.05, "maximum": 215.61, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 40.03, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.93, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 40.29, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.23 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.05 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.05 } ] } ] }, { "description": "Hc Albumin Ischemia Modified", "code_information": [ { "code": "82045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.33, "discounted_cash": 33, "minimum": 22.63, "maximum": 323.33, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 64.49, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 64.9, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.93 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.63 } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4885.53, "discounted_cash": 986, "minimum": 102.57, "maximum": 4885.53, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1006.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1761.96, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3283.7, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 853.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1381.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1874.43, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1825.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1479.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1479.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1775.77, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.68 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1529.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1886.56, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 844.69 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.57 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 454.86 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 454.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1578.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 827.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 986.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 976.67, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1967 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 853.22 } ] } ] }, { "description": "Hc Admin Pneumococcal Vac - G0009 - 77100009 - 77100009", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.43, "discounted_cash": 50, "minimum": 50.4207, "maximum": 240.43, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.96, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.52, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 96.77, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.67, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 97.39, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 50.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 62 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 62 } ] } ] }, { "description": "Hc Assay Glucose, Body Fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 276.24, "discounted_cash": 3, "minimum": 2.62, "maximum": 276.24, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.62 } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 847.38, "discounted_cash": 5, "minimum": 3.48, "maximum": 847.38, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.63 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate L/R Atrial Fibril W Isolated Pulm Vein", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13098.7, "minimum": 374.43, "maximum": 13098.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 378.21 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 385.77 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 374.43 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 378.21 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 378.21 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1048 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 9097 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc Aep Hearing Status Deter Broadband Stimuli I&R", "code_information": [ { "code": "92651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 810, "discounted_cash": 234, "minimum": 79.66, "maximum": 810, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 469.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.44, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 781.7, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 328.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 234.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 446.22, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 434.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 352.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 422.73, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.07 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 364.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 449.1, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.66 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 375.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 232.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 252 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 255 } ] } ] }, { "description": "Hc Assay Growth Hormone (Hgh)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.1, "discounted_cash": 16, "minimum": 11.11, "maximum": 182.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 31.88, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.11 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.11 } ] } ] }, { "description": "Hc Allergen Spec Ige Recombinant/Purified Compnt Ea", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.65, "discounted_cash": 17, "minimum": 10.96, "maximum": 89.65, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 34.07, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 34.29, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.96 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.96 } ] } ] }, { "description": "Hc Acetylcholinesterase Assay", "code_information": [ { "code": "82013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.78, "discounted_cash": 12, "minimum": 7.45, "maximum": 218.78, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.54 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.45 } ] } ] }, { "description": "Hc Aerosol Inhalation Treat For Pneum Carinii", "code_information": [ { "code": "94642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 958, "discounted_cash": 238, "minimum": 37.93, "maximum": 958, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 425.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 792.78, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 452.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.72, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.08 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 369.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 455.47, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.93 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.31 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 238.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 235.8, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 252 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 255 } ] } ] }, { "description": "Hc Assay Of Acetaminophen - 80329 - 30100036", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.97, "minimum": 1, "maximum": 287.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Ambl Bld Press W/Tape/Disk 24/>Hr Alys W/Reprt", "code_information": [ { "code": "93788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 996, "discounted_cash": 144, "minimum": 4.78, "maximum": 996, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.47, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 481.7, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 274.97, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.93 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 276.75, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.78 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 231.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 143.27, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 366, "discounted_cash": 32, "minimum": 21.74, "maximum": 366, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.72, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 62.38, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.03 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 32.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.74 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.74 } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Mult Step", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194, "discounted_cash": 11, "minimum": 7.99, "maximum": 194, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.99 } ] } ] }, { "description": "Hc Assay Of Acth", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 421.6, "discounted_cash": 38, "minimum": 25.75, "maximum": 421.6, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 73.38, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.52, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.88 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 73.85, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 38.23, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.75 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.75 } ] } ] }, { "description": "Hc Amino Acids, 6+ Quant", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 543, "discounted_cash": 16, "minimum": 11.24, "maximum": 543, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 32.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.24 } ] } ] }, { "description": "Hc Actigraphy Testing, 3-14 Day", "code_information": [ { "code": "95803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.54, "discounted_cash": 64, "minimum": 63.5184, "maximum": 273.54, "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 122.69, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.59, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.56, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 121.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.49, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Resistance By Impulse Oscillometry", "code_information": [ { "code": "94728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455, "discounted_cash": 139, "minimum": 24.5, "maximum": 455, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 249.95, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 455, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 265.91, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 216.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 267.63, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 223.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.75 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 138.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 252 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 255 } ] } ] }, { "description": "Hc Assay Of Amitriptyline - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.9, "discounted_cash": 22, "minimum": 11.39, "maximum": 114.9, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 43.66, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.36, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 43.94, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.79 } ] } ] }, { "description": "Hc Adenovirus Ag Eia", "code_information": [ { "code": "87301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11, "minimum": 7.99, "maximum": 138.93, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.99 } ] } ] }, { "description": "Hc Alpha-Fetoprotein, Serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.69, "discounted_cash": 16, "minimum": 11.18, "maximum": 496.69, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 31.86, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 32.07, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.31 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.18 } ] } ] }, { "description": "Hc Assay Of Amphetamines - G0480 - 30100323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.74, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Analysis, Tumor", "code_information": [ { "code": "88358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 396.22, "discounted_cash": 185, "minimum": 19.84, "maximum": 396.22, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.96, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 396.22, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 352.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.44 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 287.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 354.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 183.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 164.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.53 } ] } ] }, { "description": "Hc Adenovirus, Antibody", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.82, "discounted_cash": 12, "minimum": 8.58, "maximum": 133.82, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.78 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.58 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.58 } ] } ] }, { "description": "Hc Amino Acid Single Qual", "code_information": [ { "code": "82127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195, "discounted_cash": 14, "minimum": 9.25, "maximum": 195, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 26.94, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.52, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.12, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.25 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.25 } ] } ] }, { "description": "Hc Assay Of Barbiturates - G0480 - 30100326", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Analyze Neurostim,No Reprog", "code_information": [ { "code": "95970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.54, "discounted_cash": 144, "minimum": 21.28, "maximum": 273.54, "payers_information": [ { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.47, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.54, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 273.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 273.54, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 231.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.49 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 143.27, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Hep B Vac - G0010 - 77100010 - 77100010", "code_information": [ { "code": "G0010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.44, "discounted_cash": 50, "minimum": 27.732, "maximum": 92.44, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.96, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.44, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 92.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.67, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 92.44, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 50.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 62 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 62 } ] } ] }, { "description": "Hc Amino Acids, 2-5 Quant", "code_information": [ { "code": "82136", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.08, "discounted_cash": 19, "minimum": 11.39, "maximum": 228.08, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 37.26, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 37.5, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 19.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.77 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.77 } ] } ] }, { "description": "Hc Assay Of Calcium, Ionized", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186, "discounted_cash": 13, "minimum": 9.12, "maximum": 186, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.33 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.62, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.52 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.24 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.33 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.12 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.12 } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5857.94, "discounted_cash": 3434, "minimum": 146.72, "maximum": 5857.94, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5857.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5857.94, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5857.94, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 5857.94, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5857.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5857.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.16 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5323.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5857.94, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.72 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5495.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 } ] } ] }, { "description": "Hc Amniocentesis,Diagnostic", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 907.47, "discounted_cash": 1001, "minimum": 78.971, "maximum": 907.47, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 907.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 301.62 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 907.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 301.62 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 647.46 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 298.6 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 78.97 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 78.97 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 301.62 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 907.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 301.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 907.47, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 907.47 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 907.47 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 907.47 } ] } ] }, { "description": "Hc Assay Of Carnitine", "code_information": [ { "code": "82379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.57, "discounted_cash": 16, "minimum": 11.24, "maximum": 237.57, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 32.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.24 } ] } ] }, { "description": "Hc Angio Pulmon Bilat Select", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16401.3, "discounted_cash": 3434, "minimum": 101.11, "maximum": 16401.3, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6133.91, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.4 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11431.53, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6525.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6181.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.67 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5323.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6567.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.27 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5495.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.4 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 } ] } ] }, { "description": "Hc Agent Nos Assay W/Optic", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180, "discounted_cash": 16, "minimum": 8.1, "maximum": 180, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.93, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.64 } ] } ] }, { "description": "Hc Analyze Neurostim,Simple/Prog", "code_information": [ { "code": "95971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 687.25, "discounted_cash": 103, "minimum": 35.73, "maximum": 687.25, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 184.67, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 344.17, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 196.46, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 155.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.81 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 160.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 197.73, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 102.37, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 687.25 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 687.25 } ] } ] }, { "description": "Hc Assay Of Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.8, "discounted_cash": 10, "minimum": 7.16, "maximum": 141.8, "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.16 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.48 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.26 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.33 } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3850.74, "discounted_cash": 3434, "minimum": 97.22, "maximum": 16401.3, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.7 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3850.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67, "discounted_cash": 7, "minimum": 5.31, "maximum": 67, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.55 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 7.89, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.31 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.31 } ] } ] }, { "description": "Hc Androstanediol Glucuronide", "code_information": [ { "code": "82154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.87, "discounted_cash": 28, "minimum": 19.22, "maximum": 324.87, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 54.78, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.89, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.06 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 55.13, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.47 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 28.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.22 } ] } ] }, { "description": "Hc Assay Of Ck (Cpk)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271, "discounted_cash": 6, "minimum": 4.34, "maximum": 271, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.44 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 108.4, "10th_percentile": 108.4, "90th_percentile": 108.4, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.4 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 162.6, "10th_percentile": 4.4, "90th_percentile": 162.6, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.44 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.34 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.34 } ] } ] }, { "description": "Hc Anoscopy W Dilation", "code_information": [ { "code": "46604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1911.14, "discounted_cash": 1301, "minimum": 62.79, "maximum": 1911.14, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1327.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1911.14 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1822.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.69 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 533.79 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.79 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 585.22 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 585.22 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1911.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1911.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1301.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1288.58, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1911.14 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1911.14 } ] } ] }, { "description": "Hc Allergen Specific Igg", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.86, "discounted_cash": 7, "minimum": 3.52, "maximum": 84.86, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.63 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14.95, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.69 } ] } ] }, { "description": "Hc Angio Aortobifemoral W Cath", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16401.3, "discounted_cash": 3434, "minimum": 91.16, "maximum": 16401.3, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6133.91, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11431.53, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6525.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6181.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.95 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5323.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6567.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.92 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5495.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.93 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 } ] } ] }, { "description": "Hc Assay Of Cpk In Blood", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.71, "discounted_cash": 13, "minimum": 8.93, "maximum": 154.71, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.32 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.93 } ] } ] }, { "description": "Hc Antb Severe Aqt Respir Synd Sars-Cov-2 Covid19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.75, "discounted_cash": 42, "minimum": 20.325, "maximum": 67.75, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.49 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 67.75, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 67.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 41.71, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.28 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28 } ] } ] }, { "description": "Hc Alpha-Fetoprotein; Amniotic", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151, "discounted_cash": 17, "minimum": 11.18, "maximum": 151, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 32.51, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.31 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.18 } ] } ] }, { "description": "Hc Angio Aortogram Abd Serial", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16401.3, "discounted_cash": 3434, "minimum": 85.08, "maximum": 16401.3, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6525.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6181.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.71 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5323.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6567.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.66 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5495.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.68 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6133.91, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.68 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11431.53, "additional_payer_notes": "332.85% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cryofibrinogen", "code_information": [ { "code": "82585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90, "discounted_cash": 14, "minimum": 5.8, "maximum": 90, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 26.87, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.8 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.48 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.48 } ] } ] }, { "description": "Hc Antegrade Urography Radiological Supvj & Interpj", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1758.55, "discounted_cash": 379, "minimum": 49.38, "maximum": 1758.55, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 387.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 677.73, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.88 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1263.07, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 531.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 720.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.88 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 588.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 725.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.38 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 607.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.88 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 375.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.7 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 308.7 } ] } ] }, { "description": "Hc Analyze Neurostim,Complx/Prog", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 647.3, "discounted_cash": 103, "minimum": 68.36, "maximum": 647.3, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 184.67, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 344.17, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 196.46, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 155.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.43 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 160.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 197.73, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.05 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 102.37, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 647.3 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 647.3 } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5633.71, "discounted_cash": 6052, "minimum": 95.51, "maximum": 5633.71, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.49 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5633.71, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3501.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3501.22 } ] } ] }, { "description": "Hc Assay Of Estriol", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.7, "discounted_cash": 24, "minimum": 16.12, "maximum": 164.7, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 45.94, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.52, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 46.24, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.12 } ] } ] }, { "description": "Hc Antibody Hla Class I High Definition Panel Qual", "code_information": [ { "code": "86832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.17, "discounted_cash": 323, "minimum": 194.25, "maximum": 884.17, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 647.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 351.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 453.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 615.13, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 598.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 485.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 582.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 501.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 619.11, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 518, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 320.51, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 194.25 } ] } ] }, { "description": "Hc Angio Aortogram Thoracic", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16401.3, "discounted_cash": 3434, "minimum": 196.07, "maximum": 16401.3, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6133.91, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11431.53, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6525.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6181.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 202.01 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5323.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6567.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 196.07 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5495.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.05 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 } ] } ] }, { "description": "Hc Angio Ea Addnl Selectv Vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4369.13, "minimum": 72.02, "maximum": 4369.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.81 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.53 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.81 } ] } ] }, { "description": "Hc Assay Of Estrogen", "code_information": [ { "code": "82672", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297, "discounted_cash": 21, "minimum": 14.47, "maximum": 297, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 41.23, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.06, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.8 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.47 } ] } ] }, { "description": "Hc Antibody John Cunningham Virus", "code_information": [ { "code": "86711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5666.55, "discounted_cash": 16, "minimum": 10.13, "maximum": 5666.55, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 32.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.25, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.13 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.13 } ] } ] }, { "description": "Hc Angio Pulmon Unilat Select", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7924.56, "discounted_cash": 3434, "minimum": 99.08, "maximum": 7924.56, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6133.91, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7924.56, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6525.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6181.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.03 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5323.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6567.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.91 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5495.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16401.3, "discounted_cash": 3434, "minimum": 97.22, "maximum": 16401.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6133.91, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11431.53, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4808.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 6525.44, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6353.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5151.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6181.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.7 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 5323.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 6567.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5495.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6868.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.22 } ] } ] }, { "description": "Hc Assay Of Ethanol - G0480 - 30100052", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.17, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - G0480 - 30100422", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.51, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 217.42, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 218.82, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4380.85, "discounted_cash": 3434, "minimum": 97.22, "maximum": 16401.3, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.7 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4380.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 } ] } ] }, { "description": "Hc Angio Intern Mammary", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.26, "discounted_cash": 3434, "minimum": 130.6, "maximum": 3280.26, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.56 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.6 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.92 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2113.22 } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - 80320 - 30100071", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.17, "minimum": 1, "maximum": 187.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.82, "discounted_cash": 64, "minimum": 3.59, "maximum": 167.82, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 121.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.49, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 122.69, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.59 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.59 } ] } ] }, { "description": "Hc Antibiotic Sens, Mlc, Each", "code_information": [ { "code": "87187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.79, "discounted_cash": 40, "minimum": 7, "maximum": 115.79, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 76.32, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.31, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.21 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 62.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 76.82, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.07 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 39.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.1 } ] } ] }, { "description": "Hc Angio Pelvis", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8156.49, "discounted_cash": 6052, "minimum": 123.86, "maximum": 8156.49, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6173.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.11 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.61 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 123.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.11 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6052.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5992.06, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3501.22 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3501.22 } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - G0480 - 30100071", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.17, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 187.17, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Titer Ea Antb", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.1, "discounted_cash": 12, "minimum": 5.96, "maximum": 84.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.23 } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.95, "discounted_cash": 4, "minimum": 1.14, "maximum": 70.95, "payers_information": [ { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "185.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.89, "discounted_cash": 3434, "minimum": 113.24, "maximum": 3280.89, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.68 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.13 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.31 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 118.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 874.9 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 874.9 } ] } ] }, { "description": "Hc Assay Of Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 823.7, "discounted_cash": 13, "minimum": 9.09, "maximum": 823.7, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.53, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.49 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.21 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.49, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.09 } ] } ] }, { "description": "Hc Antistreptolysin O Screen", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.57, "discounted_cash": 5, "minimum": 3.85, "maximum": 124.57, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.85 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.85 } ] } ] }, { "description": "Hc Antibiotic Sens,Enzyme Detection,Each", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.35, "discounted_cash": 4, "minimum": 1.14, "maximum": 32.35, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.16 } ] } ] }, { "description": "Hc Assay Of Gentamicin", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 681.35, "discounted_cash": 16, "minimum": 10.92, "maximum": 681.35, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 31.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.92 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.92 } ] } ] }, { "description": "Hc Antithrombin Iii Test,Activ", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.9, "discounted_cash": 11, "minimum": 7.9, "maximum": 280.9, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.33, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.9 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.9 } ] } ] }, { "description": "Hc Antibody Detection Nos If", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.5, "discounted_cash": 16, "minimum": 8.1, "maximum": 80.5, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 30.59, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.98, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.66 } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434.41, "discounted_cash": 14, "minimum": 9.73, "maximum": 434.41, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.28, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.92, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.73 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.73 } ] } ] }, { "description": "Hc Assay Of Glucagon", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179, "discounted_cash": 14, "minimum": 9.53, "maximum": 179, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 27.15, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.53 } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1906.39, "discounted_cash": 2244, "minimum": 571.917, "maximum": 1906.39, "payers_information": [ { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1906.39 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1875 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1906.39 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1906.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1776.9 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 935.29 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 925.17 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 925.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1906.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1906.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I & Class Ii Antigens Qual", "code_information": [ { "code": "86828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1050, "discounted_cash": 64, "minimum": 38.51, "maximum": 1050, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 121.96, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.54, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 122.75, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 63.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.51 } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4712.18, "discounted_cash": 3434, "minimum": 44.26, "maximum": 4712.18, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3941.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.6 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3434.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3400.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 874.9 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 874.9 } ] } ] }, { "description": "Hc Assay Of Haloperidol", "code_information": [ { "code": "80173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162, "discounted_cash": 15, "minimum": 9.71, "maximum": 162, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 29.98, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.14 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 30.18, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.71 } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm Ea Ad 25Cm", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.05, "minimum": 48.615, "maximum": 162.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.05 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 162.05 } ] } ] }, { "description": "Hc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.33, "discounted_cash": 185, "minimum": 3.82, "maximum": 87.33, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.87 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.82 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.82 } ] } ] }, { "description": "Hc Anoscopy W Remove Foreign Body", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1441.37, "discounted_cash": 1011, "minimum": 329.38, "maximum": 1441.37, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1031.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 332.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1416.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 332.71 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1149.36 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 329.38 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 444.91 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 444.91 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1441.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 332.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 332.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1011.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 1001.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1441.37 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1441.37 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Hc Assay Of Histamine", "code_information": [ { "code": "83088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.71, "discounted_cash": 29, "minimum": 19.69, "maximum": 296.71, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 56.11, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.15, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.55 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 56.47, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 29.23, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.69 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.69 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3815.39, "discounted_cash": 2244, "minimum": 935.29, "maximum": 3815.39, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3815.39, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1210 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2289.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3815.39, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.39, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3377.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3141.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3815.39, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3815.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3366.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3815.39, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3478.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3815.39, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1558.81 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 935.29 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1652.16 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1652.16 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3590.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 3364.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 944.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2244.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 2221.82, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3060 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2511 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 3468.99 } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm Ea Ad 100Sqcm", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.06, "minimum": 304.218, "maximum": 1014.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 1012.38 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1014.06 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 1012.38 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 442.69 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 1002.26 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 1012.38 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1014.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1012.38 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1014.06 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1014.06 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1014.06 } ] } ] }, { "description": "Hc Antibody Treponema Pallidum", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.46, "discounted_cash": 13, "minimum": 8.83, "maximum": 149.46, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.21 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 25.32, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.83 } ] } ] }, { "description": "Hc Assay Of Insulin", "code_information": [ { "code": "83527", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.24, "discounted_cash": 12, "minimum": 8.63, "maximum": 123.24, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 24.76, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.63 } ] } ] }, { "description": "Hc Application Of Finger Splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293, "discounted_cash": 64, "minimum": 31.18, "maximum": 293, "payers_information": [ { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 274.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 293 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 293 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 283.4 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.59, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.56, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 283.4 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 121.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.49, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.12 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 122.69, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 280.57 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.49 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm Ea Add 100Sqcm", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 921.39, "minimum": 276.417, "maximum": 921.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 921.39 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 921.39 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 921.39 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 353.73 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 921.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 921.39 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 921.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 921.39 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 921.39 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 921.39 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 921.39 } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - 80337 - 30100422", "code_information": [ { "code": "80337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.51, "minimum": 1, "maximum": 332.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Assay Of Interleukin-6 (Il-6)", "code_information": [ { "code": "83529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270, "discounted_cash": 17, "minimum": 8.54, "maximum": 270, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 32.81, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 33.03, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 17.1, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.36 } ] } ] }, { "description": "Hc Apply Elbow To Finger Cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 457.05, "discounted_cash": 304, "minimum": 58.83, "maximum": 457.05, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.05 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 425.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.61 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.05 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.83 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 65.19 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 65.19 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 301.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 457.05 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 457.05 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.05 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm Ea Ad 25Qsqcm", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 831.3, "minimum": 134.6, "maximum": 831.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 831.3 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 668.39 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 831.3 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 668.39 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 134.6 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 661.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 668.39 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 831.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 668.39 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 831.3 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 831.3 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 831.3 } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183, "discounted_cash": 11, "minimum": 7.44, "maximum": 183, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.54 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.44 } ] } ] }, { "description": "Hc Assay Of Lead", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436.86, "discounted_cash": 12, "minimum": 8.07, "maximum": 436.86, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 23.01, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.16, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.07 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.07 } ] } ] }, { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 822.23, "discounted_cash": 176, "minimum": 47.14, "maximum": 822.23, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.62 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 588.31, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.27 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 335.83, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.15, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.57 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 273.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 338, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 426.96 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.14 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 68.94 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 68.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.62 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 418.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 174.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 822.23 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 822.23 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.27 } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.69, "discounted_cash": 144, "minimum": 26.87, "maximum": 671.69, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.47, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 481.7, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 236.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 274.97, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.68 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 276.75, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 234.08 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.87 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 231.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 143.27, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 671.69 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 671.69 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 236.44 } ] } ] }, { "description": "Hc Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.47, "discounted_cash": 7, "minimum": 4.87, "maximum": 241.47, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.93 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.98 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.87 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.87 } ] } ] }, { "description": "Hc Assay Of Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177, "discounted_cash": 6, "minimum": 4.46, "maximum": 177, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12.81, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 106.2, "10th_percentile": 106.2, "90th_percentile": 106.2, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.46 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.46 } ] } ] }, { "description": "Hc Apply Multlay Comprs Lwr Leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 822.23, "discounted_cash": 176, "minimum": 11.71, "maximum": 822.23, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 588.31, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 335.83, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.15, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.07 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 273.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 338, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 215.61 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 77.3 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 77.3 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 211.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 174.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 822.23 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 822.23 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.79 } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.34, "discounted_cash": 144, "minimum": 41.802, "maximum": 139.34, "payers_information": [ { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.34 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.8 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 139.34 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 139.34 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.34 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.34 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.34, "additional_payer_notes": "185.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aortic Dys/Dilat Genom Seq Ana", "code_information": [ { "code": "81410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13750, "discounted_cash": 504, "minimum": 302.4, "maximum": 13750, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1008, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 546.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 957.6, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 932.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 756, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 756, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 907.2, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 781.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 963.8, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 806.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 498.96, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 302.4 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 302.4 } ] } ] }, { "description": "Hc Assay Of Methadone - G0480 - 30100205", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Apply Rigid Leg Cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.17, "discounted_cash": 304, "minimum": 73.1157, "maximum": 668.17, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 608.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 543.34, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.01 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 668.17, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 668.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 425.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 578.02, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.01 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 471.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 581.76, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 668.17 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.01 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 73.12 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 73.12 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.01 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 668.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 301.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 668.17 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 668.17 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 668.17 } ] } ] }, { "description": "Hc Apply Long Arm Cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.12, "discounted_cash": 304, "minimum": 64.41, "maximum": 519.12, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 519.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 519.12, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.06 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 519.12, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 519.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 425.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 519.12, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 519.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 519.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.36 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 471.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 519.12, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 519.12 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 71.03 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 71.03 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.06 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 519.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 301.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 519.12 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 519.12 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 519.12 } ] } ] }, { "description": "Hc Apply Long Leg Cast", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 592.13, "discounted_cash": 304, "minimum": 91.9222, "maximum": 592.13, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.13, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 592.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 543.34, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 592.13, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 592.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 425.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 578.02, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 98.57 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 471.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 581.76, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 592.13 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.67 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 91.92 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 91.92 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.64 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 592.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 301.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 592.13 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 592.13 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 592.13 } ] } ] }, { "description": "Hc Assay Of Nucleotidase 5'", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.21, "discounted_cash": 11, "minimum": 7.43, "maximum": 132.21, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 21.19, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 21.32, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.43 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.43 } ] } ] }, { "description": "Hc Aquatic Therapy/Exercises Ea 15 Min", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154, "discounted_cash": 37, "minimum": 36.6696, "maximum": 154, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 70.38, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.67, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.92 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 57.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 70.83, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.78 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 154 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 154 } ] } ] }, { "description": "Hc Apply Short Leg Cast,Walker", "code_information": [ { "code": "29425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1199.55, "discounted_cash": 304, "minimum": 53.34, "maximum": 1199.55, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 608.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 543.34, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.88 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1012.6, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 445.95 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 425.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 578.02, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.96 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 471.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 581.76, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 441.49 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.34 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 54.32 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 54.32 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.88 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 301.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1048 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1055 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 445.95 } ] } ] }, { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 822.23, "discounted_cash": 176, "minimum": 47.06, "maximum": 822.23, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.54 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 588.31, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 335.83, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 265.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.15, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.49 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 273.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 338, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 405.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.06 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 50.55 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 50.55 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.54 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 397.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 174.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 822.23 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 822.23 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.6 } ] } ] }, { "description": "Hc Assay Of Osteocalcin", "code_information": [ { "code": "83937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234, "discounted_cash": 29, "minimum": 19.9, "maximum": 234, "payers_information": [ { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 56.72, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.73, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.77 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 46.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 57.08, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 29.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.9 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.9 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 918.45, "discounted_cash": 185, "minimum": 3.45, "maximum": 918.45, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.96, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 616.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 352.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 287.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 354.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.49 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 183.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.45 } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.05, "discounted_cash": 12, "minimum": 3.615, "maximum": 12.05, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.23 } ] } ] }, { "description": "Hc Apply Short Leg Cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.11, "discounted_cash": 304, "minimum": 56.39, "maximum": 534.11, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.11, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 534.11, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 483.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 425.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 534.11, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.1 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 471.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 534.11, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.5 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.39 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 57.66 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 57.66 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 468.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 301.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 534.11 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 534.11 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 483.33 } ] } ] }, { "description": "Hc Assay Of Phenothiazine - G0480 - 30100385", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Arc Blood Typing, Rbc Antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.06, "discounted_cash": 389, "minimum": 2.55, "maximum": 309.06, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.58 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.55 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.55 } ] } ] }, { "description": "Hc Arthro Hip Wo Anesth", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.34, "minimum": 65.99, "maximum": 343.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 343.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.66 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 343.34 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 660.37, "10th_percentile": 660.37, "90th_percentile": 660.37, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.99 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 343.34 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.99 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.66 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 343.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.66 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 343.34 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 343.34 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 343.34 } ] } ] }, { "description": "Hc Aquaporin-4 Antibody Flow Cytometry Each", "code_information": [ { "code": "86053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.65, "discounted_cash": 37, "minimum": 5.96, "maximum": 188.65, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 71.69, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 58.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 72.15, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 37.35, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.23 } ] } ] }, { "description": "Hc Assay Of Phenytoin, Total", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206, "discounted_cash": 13, "minimum": 8.84, "maximum": 206, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.23 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 25.34, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.84 } ] } ] }, { "description": "Hc Arc Cold Agglutinin, Titer", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.9, "discounted_cash": 8, "minimum": 5.38, "maximum": 54.9, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.45 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.38 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.38 } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.3, "discounted_cash": 15, "minimum": 10.04, "maximum": 164.3, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 28.6, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.04 } ] } ] }, { "description": "Hc Arc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.33, "discounted_cash": 185, "minimum": 3.82, "maximum": 87.33, "payers_information": [ { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.87 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.82 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.82 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.33, "additional_payer_notes": "180.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Porphyrins Urine Quan&Fxj", "code_information": [ { "code": "84120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.09, "discounted_cash": 14, "minimum": 9.81, "maximum": 191.09, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 27.95, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.24 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.81 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.81 } ] } ] }, { "description": "Hc Arc Frozen Blood Freeze & Thaw Per Unit", "code_information": [ { "code": "86932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 843, "discounted_cash": 40, "minimum": 19.27, "maximum": 843, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.55, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.2, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 77.18, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 77.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 40.21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.27 } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266, "discounted_cash": 5, "minimum": 3.45, "maximum": 266, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.49 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.45 } ] } ] }, { "description": "Hc Arc Blood Typing, Abo", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.35, "discounted_cash": 144, "minimum": 1.99, "maximum": 380.35, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 274.97, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.08 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 276.75, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.02 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 167.82, "10th_percentile": 2.02, "90th_percentile": 167.82, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 231.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 143.27, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1.99 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.99 } ] } ] }, { "description": "Hc Assay Of Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.95, "discounted_cash": 14, "minimum": 9.73, "maximum": 72.95, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 27.72, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.15 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.85 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.73 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.73 } ] } ] }, { "description": "Hc Arc Hemolysins & Agglutinins, Incubated", "code_information": [ { "code": "86941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186, "discounted_cash": 12, "minimum": 8.07, "maximum": 186, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 23.01, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.16, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.07 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.07 } ] } ] }, { "description": "Hc Assay Biotinidase", "code_information": [ { "code": "82261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117, "discounted_cash": 16, "minimum": 11.24, "maximum": 117, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 32.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.24 } ] } ] }, { "description": "Hc Arc Blood Typing, Rh (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.35, "discounted_cash": 40, "minimum": 1.99, "maximum": 380.35, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 77.18, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.12, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.08 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 77.68, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.02 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 91.53, "10th_percentile": 2.02, "90th_percentile": 91.53, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 40.21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1.99 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.99 } ] } ] }, { "description": "Hc Assay Of Pregnanetriol", "code_information": [ { "code": "84138", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.4, "discounted_cash": 21, "minimum": 12.63, "maximum": 356.4, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 40, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.89, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.18 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 40.25, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 20.84, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.63 } ] } ] }, { "description": "Hc Arc Rbc Antibody Elution", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 892.94, "discounted_cash": 185, "minimum": 15.98, "maximum": 892.94, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.96, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 616.8, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 352.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 287.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 354.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 183.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 86.84 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.84 } ] } ] }, { "description": "Hc Assay C-D Transfer Measure", "code_information": [ { "code": "82373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400, "discounted_cash": 18, "minimum": 12.04, "maximum": 400, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 34.31, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.51, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood Thaw Per Unit", "code_information": [ { "code": "86931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.59, "discounted_cash": 185, "minimum": 44.27, "maximum": 178.59, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.72 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.61 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.27 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.72 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 164.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.53 } ] } ] }, { "description": "Hc Assay Of Primidone", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.65, "discounted_cash": 16, "minimum": 11.06, "maximum": 153.65, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.3 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 31.52, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.86, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.19 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.3 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.06 } ] } ] }, { "description": "Hc Arc Rbc Antibody Identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1874.46, "discounted_cash": 389, "minimum": 21.86, "maximum": 1874.46, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 779.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 389.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 696.33, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 389.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1297.72, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 545.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 389.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 740.77, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 584.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 584.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 701.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 389.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.52 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 389.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 604.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 745.57, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 389.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 623.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 389.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 389.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 389.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 385.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 164.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.53 } ] } ] }, { "description": "Hc Assay Carbamazepine Free", "code_information": [ { "code": "80157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.08, "discounted_cash": 13, "minimum": 8.84, "maximum": 140.08, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.23 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 25.34, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.84 } ] } ] }, { "description": "Hc Arc Rbc Antibody Screen", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.35, "discounted_cash": 56, "minimum": 2.58, "maximum": 380.35, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 101.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 107.69, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 85.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.02, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 108.39, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.58 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 144.15, "10th_percentile": 144.15, "90th_percentile": 144.15, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 56.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.86 } ] } ] }, { "description": "Hc Assay Of Prostate Specific Antigen Total - 84153 - 30100312", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.62, "discounted_cash": 18, "minimum": 12.26, "maximum": 200.62, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.55 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 34.94, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 35.17, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.55 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.26 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.26 } ] } ] }, { "description": "Hc Arc Rbc Pretreat,Serum Diff Rbc Abso", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.3, "discounted_cash": 64, "minimum": 17.63, "maximum": 135.3, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.59, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.3, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 121.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.49, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.17 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 122.69, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.27 } ] } ] }, { "description": "Hc Assay For Collagen Cross Links", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.33, "discounted_cash": 18, "minimum": 12.46, "maximum": 208.33, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 35.49, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.62, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.01 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 28.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 35.72, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 18.49, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.46 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.46 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment,Serum Inhib", "code_information": [ { "code": "86977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.59, "discounted_cash": 185, "minimum": 17.63, "maximum": 178.59, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.17 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 178.59, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 86.84 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.84 } ] } ] }, { "description": "Hc Assay Of Quinidine", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.62, "discounted_cash": 14, "minimum": 9.73, "maximum": 149.62, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.73 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.73 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.28, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.92, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment,Serum Dilutn", "code_information": [ { "code": "86976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.61, "discounted_cash": 31, "minimum": 10.3, "maximum": 99.61, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.19, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.61, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 59.77, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.17 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 48.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 60.16, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.3 } ] } ] }, { "description": "Hc Assay L/S Ratio", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.29, "discounted_cash": 21, "minimum": 14.66, "maximum": 368.29, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 42.05, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.85 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.66 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment,Serum W Drugs", "code_information": [ { "code": "86975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 415.87, "discounted_cash": 485, "minimum": 15.98, "maximum": 415.87, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 415.87, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.27 } ] } ] }, { "description": "Hc Assay Of Renin", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.8, "discounted_cash": 21, "minimum": 14.66, "maximum": 149.8, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.01 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.58, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.31 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 42.05, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.01 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.66 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Den Grad Sep", "code_information": [ { "code": "86972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.66, "discounted_cash": 185, "minimum": 20.57, "maximum": 231.66, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.57 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 183.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 86.84 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.84 } ] } ] }, { "description": "Hc Assay Lipoprotein Pla2", "code_information": [ { "code": "83698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.45, "discounted_cash": 46, "minimum": 22.93, "maximum": 264.45, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 87.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.62 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 71.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 88.56, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.93 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 45.85, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.79 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.79 } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/Us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3608.65, "discounted_cash": 767, "minimum": 47.32, "maximum": 3608.65, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1535.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 783.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1371.27, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 2555.59, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.55 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1074.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 1458.8, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1420.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1151.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1382.02, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.76 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 1190.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 1468.24, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 418.32 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.32 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 50.14 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 50.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1228.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.8 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 409.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 767.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 760.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 1514 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 1522 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.55 } ] } ] }, { "description": "Hc Assay Of Salicylate - 80329 - 30100044", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.97, "minimum": 1, "maximum": 287.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Enzym", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 892.94, "discounted_cash": 185, "minimum": 11.75, "maximum": 892.94, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.96, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 616.8, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 352.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 287.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 354.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 183.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 164.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.53 } ] } ] }, { "description": "Hc Assay Of Aluminum", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 278.1, "discounted_cash": 25, "minimum": 16.99, "maximum": 278.1, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 48.41, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.14, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.86, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.73 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 39.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 48.73, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.21 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.38 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.99 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.99 } ] } ] }, { "description": "Hc Arthrogram Of Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 916.93, "discounted_cash": 379, "minimum": 77.84, "maximum": 916.93, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 387.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 677.73, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 916.93, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 531.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 720.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.2 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 588.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 725.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 607.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 375.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.7 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 308.7 } ] } ] }, { "description": "Hc Assay Of Salicylate - G0480 - 30100044", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.97, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 218.82, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 217.42, "additional_payer_notes": "190.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arterial Cath Prolngd Nfs Ther Chemotx Cutdown", "code_information": [ { "code": "36640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.26, "discounted_cash": 3434, "minimum": 911, "maximum": 3280.26, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 911 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1130.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1149.36 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 983.36 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 1514.36 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 1514.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 1126.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 993.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3280.26, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 3060 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 2511 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 1160.97 } ] } ] }, { "description": "Hc Assay Of Amikacin", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197, "discounted_cash": 15, "minimum": 10.05, "maximum": 197, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.49 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 28.84, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.05 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.05 } ] } ] }, { "description": "Hc Arthrogram Of Hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1857.89, "discounted_cash": 379, "minimum": 79.34, "maximum": 1857.89, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 387.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 677.73, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1263.07, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 531.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 720.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 588.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 725.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 607.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 375.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.7 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 308.7 } ] } ] }, { "description": "Hc Assay Of Serum Potassium", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.2, "discounted_cash": 4, "minimum": 3.07, "maximum": 50.2, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.1, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.07 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.07 } ] } ] }, { "description": "Hc Arterial Line Insertion", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 893.5, "minimum": 47.69, "maximum": 893.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.17 }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.13 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.69 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.17 }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.17 }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 893.5 } ] } ] }, { "description": "Hc Assay Of Amitriptyline - 80335 - 30100408", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "minimum": 1, "maximum": 145.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Arthrogram Of Knee Joint", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069.76, "discounted_cash": 379, "minimum": 104.03, "maximum": 1069.76, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 387.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 677.73, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1069.76, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 531.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 720.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.18 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 588.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 725.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.03 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 607.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.08 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 375.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.7 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 308.7 } ] } ] }, { "description": "Hc Assay Of Sialic Acid", "code_information": [ { "code": "84275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.65, "discounted_cash": 13, "minimum": 8.96, "maximum": 149.65, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.96 } ] } ] }, { "description": "Hc Arthrogram Of Ankle", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2370.55, "discounted_cash": 379, "minimum": 79.34, "maximum": 2370.55, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 387.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 677.73, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1263.07, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 531.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 720.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 588.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 725.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 607.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 375.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.7 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 308.7 } ] } ] }, { "description": "Hc Assay Of Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198, "discounted_cash": 14, "minimum": 9.71, "maximum": 198, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 27.68, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.14 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.86, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.71 } ] } ] }, { "description": "Hc Aspa Gene", "code_information": [ { "code": "81200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2624.89, "discounted_cash": 47, "minimum": 28.35, "maximum": 2624.89, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 89.78, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.41, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 73.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 90.36, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 46.78, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 28.35 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.35 } ] } ] }, { "description": "Hc Assay Of Sweat Sodium", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.49, "discounted_cash": 4, "minimum": 3.24, "maximum": 82.49, "payers_information": [ { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.32 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.23, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.39 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4444.64, "discounted_cash": 379, "minimum": 82.7, "maximum": 4444.64, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 387.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 677.73, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.54 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1263.07, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 531.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 720.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.21 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 588.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 725.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 607.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.54 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 375.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.7 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 308.7 } ] } ] }, { "description": "Hc Assay Of Amphetamines - 80324 - 30100323", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.74, "minimum": 1, "maximum": 169.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Aspirat/Injection Ganglion Cyst(S)", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 604.86, "discounted_cash": 333, "minimum": 38.4362, "maximum": 604.86, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 604.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 604.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 596.31, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 604.86, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 604.86 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 467.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 604.86, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 604.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.98, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.18 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 517.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 604.86, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 332.1 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 38.44 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 38.44 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 604.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 330.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 604.86 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 604.86 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 604.86 } ] } ] }, { "description": "Hc Assay Of Testosterone", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 647.13, "discounted_cash": 25, "minimum": 16.98, "maximum": 647.13, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 48.39, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 48.71, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.98 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.98 } ] } ] }, { "description": "Hc Arthrogram Of Wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2944.78, "discounted_cash": 379, "minimum": 87.94, "maximum": 2944.78, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 387.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 677.73, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 1263.07, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 531.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 720.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 569.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.61 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 588.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 725.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 607.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 379.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 375.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 308.7 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 308.7 } ] } ] }, { "description": "Hc Assay Of Androsterone", "code_information": [ { "code": "82160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.24, "discounted_cash": 25, "minimum": 16.67, "maximum": 272.24, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 48.55, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.99, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.4 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 48.86, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.89 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.67 } ] } ] }, { "description": "Hc Assay Blood Carbon Monoxide", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 278.14, "discounted_cash": 12, "minimum": 8.21, "maximum": 278.14, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 23.41, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.58 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.21 } ] } ] }, { "description": "Hc Assay Of Theophylline", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.35, "discounted_cash": 14, "minimum": 9.43, "maximum": 312.35, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 26.87, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.43 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.43 } ] } ] }, { "description": "Hc Asp/Drain Large Joint/Bursa", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.47, "discounted_cash": 333, "minimum": 33.4273, "maximum": 619.47, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 619.47, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 619.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 596.31, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.89 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 619.47, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Anthem BCBS Workers Compensation", "plan_name": "Anthem BCBS Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 619.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 467.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 619.47, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 500.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.98, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.89 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 517.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 619.47, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 619.47 }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "case rate", "standard_charge_dollar": 97.9 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "case rate", "standard_charge_dollar": 33.43 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health PPO", "methodology": "case rate", "standard_charge_dollar": 33.43 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 534.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.89 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 619.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 98.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 333.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 330.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "case rate", "standard_charge_dollar": 619.47 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "case rate", "standard_charge_dollar": 619.47 }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 619.47 } ] } ] }, { "description": "Hc Assay Of Apolipoprotein", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.53, "discounted_cash": 21, "minimum": 10.46, "maximum": 130.53, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 40.07, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.96, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.78 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 40.33, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.57 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 20.88, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.65 } ] } ] }, { "description": "Hc Assay Of 17-Hydroxypregneno", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249, "discounted_cash": 22, "minimum": 15.2, "maximum": 249, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.06, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.88 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 43.62, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.57 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.2 } ] } ] }, { "description": "Hc Assay Of Thiocyanate", "code_information": [ { "code": "84430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156, "discounted_cash": 11, "minimum": 7.76, "maximum": 156, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.61 } ] } ] }, { "description": "Hc Assay 17-(17-Ks)Ketosteroids", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.68, "discounted_cash": 12, "minimum": 8.53, "maximum": 151.68, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.91 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 24.48, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.53 } ] } ] }, { "description": "Hc Assay Of Arsenic", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169, "discounted_cash": 18, "minimum": 12.65, "maximum": 169, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 18.78, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.65 } ] } ] }, { "description": "Hc Assay Of Adp & Amp", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 385.29, "discounted_cash": 25, "minimum": 17.2, "maximum": 385.29, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.95 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 39.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 49.34, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.2 } ] } ] }, { "description": "Hc Assay Of Thyroxine Bndng Globulin", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168, "discounted_cash": 14, "minimum": 9.86, "maximum": 168, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 28.08, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 28.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.99 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.86 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.86 } ] } ] }, { "description": "Hc Assay Blood Carbon Dioxide", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202, "discounted_cash": 4, "minimum": 3.26, "maximum": 202, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.41 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.31 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.26 } ] } ] }, { "description": "Hc Assay Of Barbiturates - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166, "minimum": 1, "maximum": 166, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Assay Of Alcohol (Ethanol) Breath", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.26, "discounted_cash": 30, "minimum": 1, "maximum": 76.26, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 57, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 57.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 29.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 18 } ] } ] }, { "description": "Hc Assay Of Total Testosterone", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.04, "discounted_cash": 25, "minimum": 17.21, "maximum": 654.04, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 49.04, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.46, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.96 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 49.36, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.43 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.21 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.21 } ] } ] }, { "description": "Hc Assay For Calprotectin Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.2, "discounted_cash": 19, "minimum": 13.09, "maximum": 214.2, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 37.3, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 37.54, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.26 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.09 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.09 } ] } ] }, { "description": "Hc Assay Of Blood Chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245, "discounted_cash": 4, "minimum": 3.07, "maximum": 245, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.2 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 4.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.07 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.07 } ] } ] }, { "description": "Hc Assay Of Aldosterone", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 371.92, "discounted_cash": 40, "minimum": 27.17, "maximum": 371.92, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.35, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.36 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 77.93, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 40.34, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.17 } ] } ] }, { "description": "Hc Assay Of Total Thyroxine", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.66, "discounted_cash": 6, "minimum": 4.58, "maximum": 238.66, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.78 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.58 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.58 } ] } ] }, { "description": "Hc Assay Of 5-Hiaa", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.41, "discounted_cash": 12, "minimum": 8.6, "maximum": 302.41, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 24.67, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.6 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.6 } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Ldl Cholest", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.74, "discounted_cash": 10, "minimum": 6.36, "maximum": 109.74, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.64 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.44 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.36 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.36 } ] } ] }, { "description": "Hc Assay Of Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378.08, "discounted_cash": 6, "minimum": 4.32, "maximum": 378.08, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.32 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.32 } ] } ] }, { "description": "Hc Assay Of Triglycerides", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.36, "discounted_cash": 5, "minimum": 3.83, "maximum": 286.36, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.88 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.92 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.83 } ] } ] }, { "description": "Hc Assay Of Acetaminophen - G0480 - 30100036", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.97, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 217.42, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 218.82, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cadmium", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.88, "discounted_cash": 23, "minimum": 15.43, "maximum": 145.88, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 44.92, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 36.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 45.21, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.43 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.43 } ] } ] }, { "description": "Hc Assay Of B Hexosaminidase", "code_information": [ { "code": "83080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.73, "discounted_cash": 16, "minimum": 11.24, "maximum": 274.73, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 32.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.24 } ] } ] }, { "description": "Hc Assay Of Urine Hemoglobin", "code_information": [ { "code": "83069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.75, "discounted_cash": 3, "minimum": 2.63, "maximum": 107.75, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.75 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.67 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.63 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.63 } ] } ] }, { "description": "Hc Assay Of Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.07, "discounted_cash": 9, "minimum": 6.47, "maximum": 131.07, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.55 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47 } ] } ] }, { "description": "Hc Assay Of Calcium In Urine", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.95, "discounted_cash": 6, "minimum": 4.02, "maximum": 103.95, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.08 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5.97, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.02 } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.74, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Assay Of Urobilinogen Urine Quan Tmd Spec", "code_information": [ { "code": "84580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.75, "discounted_cash": 9, "minimum": 4.79, "maximum": 139.75, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 18.15, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.94 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.73 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.73 } ] } ] }, { "description": "Hc Assay Of Androstenedione", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.5, "discounted_cash": 29, "minimum": 19.52, "maximum": 319.5, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 55.63, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.7, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.37 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 55.99, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.77 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 28.99, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 19.52 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.52 } ] } ] }, { "description": "Hc Assay Of Chloramphenicol", "code_information": [ { "code": "82415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201, "discounted_cash": 12, "minimum": 8.45, "maximum": 201, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 24.23, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.45 } ] } ] }, { "description": "Hc Assay Of Blood Fatty Acids", "code_information": [ { "code": "82725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145, "discounted_cash": 18, "minimum": 8.99, "maximum": 145, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.79, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 35.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.99 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.26 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.26 } ] } ] }, { "description": "Hc Assay Of Valproic Acid, Free", "code_information": [ { "code": "80165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.6, "discounted_cash": 13, "minimum": 9.03, "maximum": 233.6, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.73, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 25.89, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.03 } ] } ] }, { "description": "Hc Assay Of Angiotensin Ii", "code_information": [ { "code": "82163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.25, "discounted_cash": 20, "minimum": 13.68, "maximum": 339.25, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 38.99, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 39.24, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.68 } ] } ] }, { "description": "Hc Assay Of Chromium", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 460.03, "discounted_cash": 20, "minimum": 13.52, "maximum": 460.03, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 38.53, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.12 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 31.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 38.78, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.52 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.52 } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Hdl Cholest", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.14, "discounted_cash": 8, "minimum": 5.46, "maximum": 124.14, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.7 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 15.66, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.53 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.46 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.46 } ] } ] }, { "description": "Hc Assay Of Vitamin E", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.55, "discounted_cash": 14, "minimum": 9.45, "maximum": 158.55, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 26.94, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.52, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.86 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.12, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.57 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.67 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.45 } ] } ] }, { "description": "Hc Assay Of Ascorbic Acid", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123, "discounted_cash": 9, "minimum": 6.59, "maximum": 123, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.8, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.87 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 18.91, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.74 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.59 } ] } ] }, { "description": "Hc Assay Of Copper", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161, "discounted_cash": 12, "minimum": 8.27, "maximum": 161, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.64 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.73, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.39 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.27 } ] } ] }, { "description": "Hc Assay Of Blood Pku", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.03, "discounted_cash": 5, "minimum": 3.67, "maximum": 277.03, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 10.52, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.71 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.75 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.67 } ] } ] }, { "description": "Hc Assay Of Zinc", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140, "discounted_cash": 11, "minimum": 7.59, "maximum": 140, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.69 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.59 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.59 } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - 80346 - 30100410", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.74, "minimum": 1, "maximum": 169.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Assay Of Corticosterone", "code_information": [ { "code": "82528", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.17, "discounted_cash": 22, "minimum": 15.01, "maximum": 345.17, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.54, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.67 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 34.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 43.06, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.21 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.01 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.01 } ] } ] }, { "description": "Hc Assay Of C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.6, "discounted_cash": 20, "minimum": 13.88, "maximum": 213.6, "payers_information": [ { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.48 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.06 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 20.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 39.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.46, "additional_payer_notes": "180.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphatase Acid Prostatic", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111, "discounted_cash": 9, "minimum": 6.44, "maximum": 111, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.72 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.44 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.44 } ] } ] }, { "description": "Hc Assay Of Blood Osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.48, "discounted_cash": 6, "minimum": 4.41, "maximum": 122.48, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.46 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.41 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.41 } ] } ] }, { "description": "Hc Assay Of Creatine", "code_information": [ { "code": "82540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.5, "discounted_cash": 4, "minimum": 3.09, "maximum": 119.5, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.13 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.09 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.09 } ] } ] }, { "description": "Hc Assay Of Calcitonin", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400, "discounted_cash": 26, "minimum": 17.86, "maximum": 400, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.27 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 50.9, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 51.23, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.09 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.27 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.86 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.86 } ] } ] }, { "description": "Hc Assay Phosphatase Acid, Total", "code_information": [ { "code": "84060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113, "discounted_cash": 7, "minimum": 4.93, "maximum": 113, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 14.52, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.14 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.99 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.93 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.93 } ] } ] }, { "description": "Hc Assay Of Carbamazepine Total", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159, "discounted_cash": 14, "minimum": 9.71, "maximum": 159, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 27.68, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.14 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.86, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.71 } ] } ] }, { "description": "Hc Assay Of Cyanide", "code_information": [ { "code": "82600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.97, "discounted_cash": 19, "minimum": 12.93, "maximum": 174.97, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.23 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 36.86, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.92, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 37.1, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.23 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.93 } ] } ] }, { "description": "Hc Assay Of Calcium, Total", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.5, "discounted_cash": 5, "minimum": 3.44, "maximum": 149.5, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.59 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.87, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.44 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.44 } ] } ] }, { "description": "Hc Assay Phosphohexose Enzymes", "code_information": [ { "code": "84087", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491, "discounted_cash": 10, "minimum": 6.88, "maximum": 491, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 20.39, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.88 } ] } ] }, { "description": "Hc Assay Of Carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.5, "discounted_cash": 9, "minimum": 6.15, "maximum": 121.5, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.42 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.29 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.15 } ] } ] }, { "description": "Hc Assay Of Doxepin - 80335 - 30100409", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "minimum": 1, "maximum": 145.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Assay Of Citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.5, "discounted_cash": 27, "minimum": 18.53, "maximum": 248.5, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.43, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.04, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 43.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 53.16, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.78 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 27.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.53 } ] } ] }, { "description": "Hc Assay Sngl Organic Acid, Quantitative", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.05, "discounted_cash": 21, "minimum": 11.12, "maximum": 252.05, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.23 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 40.3, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.24, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.45 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 32.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 40.56, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.23 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.73 } ] } ] }, { "description": "Hc Assay Of Cocaine - 80353 - 30100327", "code_information": [ { "code": "80353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.75, "minimum": 1, "maximum": 181.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Assay Of Estrogens", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.6, "discounted_cash": 32, "minimum": 21.53, "maximum": 352.6, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 61.37, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 50.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 61.77, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 31.98, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.53 } ] } ] }, { "description": "Hc Assay Of Cocaine - G0480 - 30100327", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.75, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 181.75, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.75, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 181.75, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Assay Test For Blood Fecal", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.01, "discounted_cash": 15, "minimum": 10.6, "maximum": 65.01, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 30.25, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.66, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 30.44, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.6 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.6 } ] } ] }, { "description": "Hc Assay Of Corticosteroids", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.94, "discounted_cash": 17, "minimum": 11.68, "maximum": 195.94, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 34.01, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.12, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 34.23, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.95 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.68 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.68 } ] } ] }, { "description": "Hc Assay Of Estrone", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.4, "discounted_cash": 24, "minimum": 16.64, "maximum": 272.4, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 47.41, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 38.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 47.71, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 24.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.64 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.64 } ] } ] }, { "description": "Hc Assay Of Creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177, "discounted_cash": 5, "minimum": 3.41, "maximum": 177, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.57 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.47 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 106.2, "10th_percentile": 106.2, "90th_percentile": 5328, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.41 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.41 } ] } ] }, { "description": "Hc Assay Tyrosine", "code_information": [ { "code": "84510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232, "discounted_cash": 10, "minimum": 6.94, "maximum": 232, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 16.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 10.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.94 } ] } ] }, { "description": "Hc Assay Of Desipramine - 80335 - 30100403", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "minimum": 1, "maximum": 145.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Assay Of Ethanol - 80320 - 30100052", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.17, "minimum": 1, "maximum": 187.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Assay Of Cryoglobulin", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107, "discounted_cash": 6, "minimum": 4.31, "maximum": 107, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.42 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.31 } ] } ] }, { "description": "Hc Assay Urea Nitrogen, Quan", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177, "discounted_cash": 3, "minimum": 2.63, "maximum": 177, "payers_information": [ { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.67 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 106.2, "10th_percentile": 106.2, "90th_percentile": 106.2, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 3.91, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.63 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.63 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.75 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Desipramine - G0480 - 30100403", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Assay Of Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214, "discounted_cash": 14, "minimum": 9.94, "maximum": 214, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 28.31, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.82, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 28.49, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.94 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.94 } ] } ] }, { "description": "Hc Assay Of Cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 289, "discounted_cash": 18, "minimum": 12.04, "maximum": 289, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 34.3, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.49, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 34.52, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.04 } ] } ] }, { "description": "Hc Assay Vit D, 1,25-Dihydroxy W Fractions", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392, "discounted_cash": 38, "minimum": 25.67, "maximum": 392, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.27 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 73.15, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.3, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.8 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 59.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 73.62, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.01 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.27 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.67 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.67 } ] } ] }, { "description": "Hc Assay Of Dibucaine Number", "code_information": [ { "code": "82638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.72, "discounted_cash": 12, "minimum": 8.17, "maximum": 127.72, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.05, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 18.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 23.43, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.28 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.36 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.17 } ] } ] }, { "description": "Hc Assay Of Fetal Fibronectin", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703, "discounted_cash": 64, "minimum": 25.1, "maximum": 703, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 122.38, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.94, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.86 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 123.17, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 103.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.94 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.94 } ] } ] }, { "description": "Hc Assay Of Doxepin - G0480 - 30100409", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Assay, Blood Catecholamines", "code_information": [ { "code": "82383", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.57, "discounted_cash": 29, "minimum": 16.93, "maximum": 315.57, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 55.25, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.34, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.44 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 45.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 55.61, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.93 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 28.79, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.45 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.45 } ] } ] }, { "description": "Hc Assay Of Digoxin", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.45, "discounted_cash": 13, "minimum": 8.85, "maximum": 90.45, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.9, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.24 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.97 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.85 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.85 } ] } ] }, { "description": "Hc Assay Of Folic Acid, Rbc", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.77, "discounted_cash": 17, "minimum": 11.55, "maximum": 70.77, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.77, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.06 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 33.75, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.82 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.55 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.55 } ] } ] }, { "description": "Hc Assay Of Endocrine Hormone", "code_information": [ { "code": "84235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.79, "discounted_cash": 71, "minimum": 35.34, "maximum": 398.79, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 135.34, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.21, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.41 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 110.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 136.21, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.34 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 70.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.74 } ] } ] }, { "description": "Hc Assay, Urine Catecholamines", "code_information": [ { "code": "82382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.72, "discounted_cash": 27, "minimum": 11.61, "maximum": 188.72, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 51.87, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.96 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 42.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 52.21, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.73 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.38 } ] } ] }, { "description": "Hc Assay Of Ethosuximide", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.19, "discounted_cash": 16, "minimum": 10.89, "maximum": 174.19, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 31.05, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.41, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 31.25, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.89 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.89 } ] } ] }, { "description": "Hc Assay Of For Hva", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175, "discounted_cash": 22, "minimum": 13.07, "maximum": 175, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 42.58, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.34, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 42.85, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.07 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.45 } ] } ] }, { "description": "Hc Assay Of Erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225, "discounted_cash": 18, "minimum": 12.53, "maximum": 225, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 35.7, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.82, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.09 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 35.93, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.83 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.53 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.53 } ] } ] }, { "description": "Hc Auditory Function 60 Min", "code_information": [ { "code": "92620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.75, "discounted_cash": 139, "minimum": 73.04, "maximum": 589.75, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 142.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 249.95, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 465.82, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 265.91, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 209.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.91, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.26 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 216.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 267.63, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.04 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 223.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.78 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 138.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 252 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 255 } ] } ] }, { "description": "Hc Assay Of Fentanyl - G0480 - 30100020", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.27, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.27, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 217.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 217.27, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183, "discounted_cash": 16, "minimum": 10.97, "maximum": 183, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 31.27, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.63, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 25.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 31.48, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.97 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.97 } ] } ] }, { "description": "Hc Assay Of Fentanyl - 80354 - 30100020", "code_information": [ { "code": "80354", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.27, "minimum": 1, "maximum": 217.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Autologous Blood Process", "code_information": [ { "code": "86890", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 471.93, "discounted_cash": 185, "minimum": 50.14, "maximum": 471.93, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 330.96, "additional_payer_notes": "178.60% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 471.93, "additional_payer_notes": "332.85% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 352.09, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 333.56, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 287.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 354.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.14 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 183.46, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 86.84 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.84 } ] } ] }, { "description": "Hc Assay Of Free Thyroxine", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.9, "discounted_cash": 9, "minimum": 6.01, "maximum": 299.9, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 560.81, "10th_percentile": 560.81, "90th_percentile": 560.81, "count": "1 through 10" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.27 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.09 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 179.94, "10th_percentile": 179.94, "90th_percentile": 179.94, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.01 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.01 } ] } ] }, { "description": "Hc Assay Of Hemosiderin, Qual", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85, "discounted_cash": 4, "minimum": 3.16, "maximum": 85, "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.21 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.3 } ] } ] }, { "description": "Hc Assay Of Fluoride", "code_information": [ { "code": "82735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 257.4, "discounted_cash": 18, "minimum": 12.36, "maximum": 257.4, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 35.23, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.3, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.37, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 28.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 35.45, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.36 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.36 } ] } ] }, { "description": "Hc B-12 Binding Capacity", "code_information": [ { "code": "82608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128, "discounted_cash": 14, "minimum": 9.55, "maximum": 128, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 27.21, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.97 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.67 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.55 } ] } ] }, { "description": "Hc Assay Of Galactose", "code_information": [ { "code": "82760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.04, "discounted_cash": 11, "minimum": 7.46, "maximum": 76.04, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.79 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.46 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.46 } ] } ] }, { "description": "Hc Assay Of Imipramine - G0480 - 30100017", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "discounted_cash": 114, "minimum": 12, "maximum": 572.15, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.46 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Prominence Health First", "plan_name": "Prominence Health First Commercial HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 74.87, "10th_percentile": 74.87, "90th_percentile": 74.87, "count": "1 through 10" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.18 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 112.3, "10th_percentile": 112.3, "90th_percentile": 343.29, "count": "20" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.66 } ] } ] }, { "description": "Hc Assay Of Flurazepam - 80346 - 30100014", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.74, "minimum": 1, "maximum": 169.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "Hc Bartonella Dna Quant", "code_information": [ { "code": "87472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 349.74, "discounted_cash": 42, "minimum": 28.56, "maximum": 349.74, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.22 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 81.4, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.25, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.11, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.8 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 81.92, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.93 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.22 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 28.56 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.56 } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Iga, Igd, Igg, Igm, Each", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170, "discounted_cash": 9, "minimum": 4.52, "maximum": 170, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest", "plan_name": "Triwest", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "UHC", "plan_name": "UHC Options PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.2 } ] } ] }, { "description": "Hc Assay Of Iron", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 735.34, "discounted_cash": 6, "minimum": 3.85, "maximum": 735.34, "payers_information": [ { "payer_name": "6 Degrees Health", "plan_name": "6 Degrees Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Alignment", "plan_name": "Alignment Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.89 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem PAR PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Services Tricare", "plan_name": "Health Net Federal Services Tricare (1/1/2025 - 12/31/2025)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Services Coalition", "plan_name": "Health Services Coalition", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "190.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Company Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "180.00% of Medicare Rates" }, { "payer_name": "Intermountain Healthcare (HCP)", "plan_name": "Healthcare Partner SR Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.97 }, { "payer_name": "Molina Healthcare", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Nevada Health Partners", "plan_name": "Nevada Health Partners (% of Medicare)", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "191.23% of Medicare Rates" }, { "payer_name": "Renal Payor Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sierra (HPN) Medicaid", "plan_name": "HPN Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.85 }, { "payer_name": "Sierra Health", "plan_name": "Sierra Health HMO/SHL", "methodology": "percent of total billed charges", "standard_charge_percentage": 60, "standard_charge_algorithm": "Not To Exceed $5624", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 441.2, "10th_percentile": 441.2, "90th_percentile": 441.2, "count": "1 through 10" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Commercial Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.89 }, { "payer_name": "Silver Summit", "plan_name": "Silver Summit Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes