{ "hospital_name": "Centinela Hospital Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Centinela Hospital Medical Center" ], "hospital_address": [ "555 East Hardy Street Inglewood, CA 90301" ], "license_information": { "license_number": "261150758", "state": "CA" }, "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": "Mohammad Abdelnaser" }, "type_2_npi": [ "1336328244", "1104005990" ], "standard_charge_information": [ { "description": "17-ALPHA-HYDROXYPROGESTERONE", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.5, "discounted_cash": 27, "minimum": 3.1726, "maximum": 86.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 36.91 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.66, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.66, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.67 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 30.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.66, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "17-OH PROGESTERONE LCMS LC", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.4, "discounted_cash": 27, "minimum": 3.1726, "maximum": 86.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "18-HYDROXYCORTICOSTERONE, S LC", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.98, "discounted_cash": 24, "minimum": 4.1025, "maximum": 314.85, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.55 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.17 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.37 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "24HR URINE FOR ALA", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.74, "discounted_cash": 16, "minimum": 4.3191, "maximum": 19.74, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "5-HIAA,QUANT.,24 HR URINE LC", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8.33, "discounted_cash": 12, "minimum": 1.8226, "maximum": 8.33, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AABB-ABO TYPE", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20, "discounted_cash": 170, "minimum": 2.73, "maximum": 116, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 3.49 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AABB-RBC ANTIBODY TITER", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78, "discounted_cash": 218, "minimum": 4.84, "maximum": 78, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.85 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.52 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN,ADD OBLIQUE/CONE", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 730, "discounted_cash": 133, "minimum": 25.06, "maximum": 730, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.27 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 45.97 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 444.86, "10th_percentile": 219, "90th_percentile": 1001.4, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 207.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "90-3561 WIRE WICK 12", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ABDOMEN,SINGLE VIEW(KUB)", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600, "discounted_cash": 111, "minimum": 16.73, "maximum": 600, "payers_information": [ { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.06 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 180, "10th_percentile": 180, "90th_percentile": 572.1, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AABB-AG SCRN,RGNT SER,EA UNIT", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 458, "minimum": 2.62, "maximum": 137, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "A-STREPTOLYSIN O", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141, "discounted_cash": 7, "minimum": 3.1945, "maximum": 141, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 9.12 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.26 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 1", "code_information": [ { "code": "2511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3970.07, "maximum": 4367.08, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4367.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AABB-ANTIBODY ID PER BA", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 458, "minimum": 6.3452, "maximum": 600, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.61 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AABB-RH TYPE", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 47, "minimum": 1.8598, "maximum": 230.44, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AABB-DAT, EACH ANTISERA", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12, "discounted_cash": 75, "minimum": 1.9692, "maximum": 154, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.79 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.05 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 4", "code_information": [ { "code": "2514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10145.16, "maximum": 11159.68, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11159.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AABB-ANTIBODY SCRN, EA TECH", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 66, "minimum": 2.98, "maximum": 225, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.77, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABD W/BILAT ILIOFEMORAL", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 104.04, "maximum": 9818.61, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4121.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 426.22 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 405.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 114.44 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AABB-DIFF ADS OF SER PER ADS", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26, "discounted_cash": 75, "minimum": 5.6888, "maximum": 37, "payers_information": [ { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26 } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 2", "code_information": [ { "code": "5642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3745.55, "maximum": 4120.11, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4120.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AABB-PRESCRN UNIT W/PAT SERUM", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 75, "minimum": 6.84, "maximum": 104, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.18 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.84 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.64 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 3", "code_information": [ { "code": "2513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6680.75, "maximum": 7348.83, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7348.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AABB-ELUTION (PREP OF ELUATE)", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70, "discounted_cash": 218, "minimum": 12.6904, "maximum": 70, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.34 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 32.7 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AABB-RBC PHENOT OTH THAN ABO/D", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26, "discounted_cash": 458, "minimum": 3.0632, "maximum": 26, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.65 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABLATION ATRIOVENTRICULAR FNCT - 93650 - 752093650", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17163.8, "discounted_cash": 9982, "minimum": 200, "maximum": 17163.8, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15472.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17163.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15672.54, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14973.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12755.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10182.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1077.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14973.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14973.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10082.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15672.54, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15672.54, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13975.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14574.46, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14035.41, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1129.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10581.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AABB-PRETREATMENT W/ENZYME", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 218, "minimum": 3.7743, "maximum": 100, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.81 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACHR MODULATING ANTIBODIES LC", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 18, "minimum": 5.4437, "maximum": 180, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABD W/BILATERAL ILIOFEMORAL", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 104.04, "maximum": 9818.61, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4121.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 426.22 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 405.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 114.44 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABLATION VT", "code_information": [ { "code": "93655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12914.2, "minimum": 200, "maximum": 12914.2, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1408.46 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1341.39 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 362.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 329.8 } ] } ] }, { "description": "AABB-RH PHENOTYPE COMPLETE", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70, "discounted_cash": 47, "minimum": 5.1418, "maximum": 70, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.19, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACOUS ELECTR CARD MULTI AV+VV", "code_information": [ { "code": "93799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408.96, "discounted_cash": 164, "minimum": 42.4472, "maximum": 408.96, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 240.43, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 329.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABDOMEN SERIES,ACUTE COMPLT", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 539, "discounted_cash": 133, "minimum": 36.75, "maximum": 926, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 69.04 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 65.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.43 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 207.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABLATION-AV NODE", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15943, "discounted_cash": 9982, "minimum": 200, "maximum": 17163.8, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14973.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12755.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10182.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1077.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14973.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14973.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10082.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15672.54, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15672.54, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13975.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14574.46, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14035.41, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1129.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10581.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15472.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15943, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15672.54, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AB ID LEUKOCYTE AB", "code_information": [ { "code": "86021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71, "discounted_cash": 15, "minimum": 15.05, "maximum": 71, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.6 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.67 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACOUS ELECTR CARD MULTI AV/VV", "code_information": [ { "code": "93799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408.96, "discounted_cash": 164, "minimum": 42.4472, "maximum": 408.96, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 240.43, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 329.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Abltj mal prst8 tiss hifu", "code_information": [ { "code": "55880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31250, "discounted_cash": 12115, "minimum": 200, "maximum": 31250, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18173.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15481.8, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12358.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 879.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18173.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18173.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12236.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19021.79, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19021.79, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16962.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17689.05, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17034.8, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 921.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12842.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18779.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24231.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19021.79, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 837.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12115.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15960.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABD CATHETER W/SERIAL", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9631.53, "discounted_cash": 4041, "minimum": 102.25, "maximum": 9631.53, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4121.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 389.15 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 370.62 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 112.48 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8082.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACOUSTIC REFLEX DECAY", "code_information": [ { "code": "92570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408.96, "discounted_cash": 164, "minimum": 26.84, "maximum": 408.96, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.18 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 240.43, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.52 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 329.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABLATION SUPRAVENTACHY", "code_information": [ { "code": "93653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55548.4, "discounted_cash": 33452, "minimum": 200, "maximum": 55548.4, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50179.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42746.81, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 659.46 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34121.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1408.46 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1341.39 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 659.46 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50179.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 659.46 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50179.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33787.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52521.08, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52521.08, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46834.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48841.26, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 47034.81, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 725.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 659.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35460.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 659.46 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 659.46 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 659.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 51852.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55548.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 659.46 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52521.08, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 659.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33452.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44069.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 1", "code_information": [ { "code": "5431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4539.67, "maximum": 4993.64, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4993.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABD CATHETER, W/SERIAL", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 102.25, "maximum": 9631.53, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4121.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 389.15 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 370.62 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 112.48 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABO TYPE", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.5, "discounted_cash": 170, "minimum": 2.73, "maximum": 116, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 3.49 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 2", "code_information": [ { "code": "5432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5975.15, "maximum": 6572.66, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6572.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABD PARACENTE W/O IMG GUIDANCE", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.4, "discounted_cash": 520, "minimum": 73.34, "maximum": 932.4, "payers_information": [ { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 806.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 932.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 816.84, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 780.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 664.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 530.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.01 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 780.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 780.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 525.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 816.84, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 816.84, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 728.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 759.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.51, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 80.67 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 73.34 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 4", "code_information": [ { "code": "5644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14390.43, "maximum": 15829.47, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15829.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 4", "code_information": [ { "code": "5434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17669.85, "maximum": 19436.83, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19436.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMEN/CHEST,DET FORBDY", "code_information": [ { "code": "76010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 376, "discounted_cash": 111, "minimum": 22.43, "maximum": 376, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.81 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 37.91 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.67 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 2", "code_information": [ { "code": "1932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9819.71, "maximum": 10801.68, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10801.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8978, "minimum": 5811.95, "maximum": 36821.5898, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 8529.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16015.09 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 8700.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16015.09 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 8529.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8529.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8615.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15684.88 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11672.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 8978.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 8978.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16269.04, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13108.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12623.77, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8529.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16180.19 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9041.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 8978.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8529.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8978.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8529.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16015.09 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13916.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14365.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16015.09 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16015.09 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16510.4 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16345.3 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8529.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16015.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8978.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5811.95 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16510.4 } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 2", "code_information": [ { "code": "2512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5154.21, "maximum": 5669.63, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5669.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10192, "minimum": 5936, "maximum": 18469.1724, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 9680.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16422.78 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 9874.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16422.78 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 9680.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9680.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9777.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16084.17 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13250.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 10192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 10192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 18469.17, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14881.34, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 14330.94, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9680.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16592.09 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10261.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 10192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 9680.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9680.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16422.78 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15798.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 16308.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16422.78 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16422.78 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16930.7 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16761.39 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9680.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16422.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8323.24 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16930.7 } ] } ] }, { "description": "AC JOINT BILATERAL", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325, "discounted_cash": 111, "minimum": 26.75, "maximum": 799, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 43.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.43 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 3", "code_information": [ { "code": "5643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6403.11, "maximum": 7043.42, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7043.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABG ANALYSIS", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450, "discounted_cash": 78, "minimum": 27.88, "maximum": 450, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 38.23 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.67, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.67, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 78.77 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 115 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 30.67 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 122.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.67, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.77, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17817, "minimum": 9757.53, "maximum": 32286.1616, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 16908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27012.17 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 17246.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27012.17 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 16908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 17077.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26455.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23163.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 17817.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 17817.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 32286.16, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26014.24, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 25052.07, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27290.65 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17922.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 17817.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 16908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17817.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27012.17 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27617.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 28508.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27012.17 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27012.17 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27847.6 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27569.12 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16908, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27012.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17817.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9757.53 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27847.6 } ] } ] }, { "description": "AC JNTS BILAT W/OR W/O WEIGHTS", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504, "discounted_cash": 111, "minimum": 26.75, "maximum": 799, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 43.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.43 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABLATION ATRIOVENTRICULAR FNCT - 93650 - 45793650", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15943, "discounted_cash": 9982, "minimum": 200, "maximum": 17163.8, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14973.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12755.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10182.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1077.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14973.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14973.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10082.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15672.54, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15672.54, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13975.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14574.46, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14035.41, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1129.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10581.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15472.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15943, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15672.54, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28022, "minimum": 20552.7829, "maximum": 50777.2955, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 26580, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46796.2 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 27111.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46796.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 26580, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 26580, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 26845.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 45831.33 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 36429.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 28022.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 28022.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 50777.3, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 40913.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 39400.04, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 26580, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47278.63 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 28174.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 28022.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 26580, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28022.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 26580, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46796.2 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 43435.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 44836.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46796.2 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46796.2 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48243.5 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 47761.07 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 26580, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 46796.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28022.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37884.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48243.5 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10626, "minimum": 9450, "maximum": 19255.5985, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 10092.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18434.07 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 10293.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18434.07 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 10092.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10092.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10193.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18053.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13814.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 10626.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 10626.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 19255.6, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15515, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 14941.15, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10092.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18624.12 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10697.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 10626.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 10092.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10626.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10092.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18434.07 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16471.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 17002.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18434.07 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18434.07 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19004.2 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18814.16 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10092.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18434.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10626.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10815.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19004.2 } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 2", "code_information": [ { "code": "7562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4969.75, "maximum": 5466.73, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5466.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACETYCHOLN RECEPT BIND AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.75, "discounted_cash": 18, "minimum": 5.4437, "maximum": 180, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 3", "code_information": [ { "code": "5433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9671.72, "maximum": 10638.89, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10638.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 1", "code_information": [ { "code": "1451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3855.58, "maximum": 4241.14, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4241.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACOUSTIC REFLEX TESTING", "code_information": [ { "code": "92568", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.4, "discounted_cash": 47, "minimum": 13.31, "maximum": 95.4, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.98 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.03, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.03, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.19, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.03, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACTIN (SMOOTH MUSCLE) AB LC", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8.76, "discounted_cash": 11, "minimum": 1.9167, "maximum": 220, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2923.44, "maximum": 3215.78, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3215.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 1", "code_information": [ { "code": "4691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4013.54, "maximum": 4414.89, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4414.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACTH, PLASMA LC", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.24, "discounted_cash": 38, "minimum": 16.9001, "maximum": 77.24, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 55.39 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 52.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.3 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.33 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 2", "code_information": [ { "code": "4692", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5463.76, "maximum": 6010.14, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6010.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 1", "code_information": [ { "code": "7561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3331.89, "maximum": 3665.08, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3665.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACETAMNOPHN QUANT", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.7, "discounted_cash": 62, "minimum": 3.1201, "maximum": 359.15, "payers_information": [ { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.37 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 47.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.86, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.28, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 45078.63, "maximum": 49586.49, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 49586.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18754.23, "maximum": 20629.65, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20629.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 3", "code_information": [ { "code": "7563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7029.52, "maximum": 7732.47, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7732.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACHR BINDING ABS, SERUM LC", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.72, "discounted_cash": 18, "minimum": 5.4437, "maximum": 180, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 2", "code_information": [ { "code": "1902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7316.81, "maximum": 8048.49, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8048.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 56449, "minimum": 25115.1178, "maximum": 115385, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 53522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 95670.34 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 56734.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 56449.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 53522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56449.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 53522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 94694.12 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 87497.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 90319.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 94694.12 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 94694.12 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 97622.8 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 96646.57 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 53522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 94694.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56449.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 115385 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 97622.8 }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 53522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 94694.12 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 54593.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 94694.12 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 53522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 53522.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 54058.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 92741.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 73384.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 56449.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 56449.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 102287.07, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 82416.74, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 79368.45, "additional_payer_notes": "140.60% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 3", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6782.52, "maximum": 7460.77, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7460.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACHR BLOCKING ABS", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.88, "discounted_cash": 18, "minimum": 5.4437, "maximum": 180, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7455, "minimum": 7086.86, "maximum": 13510.0908, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 7086.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12694.88 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 7228.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12694.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 7086.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7086.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7157.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12433.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9692.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7455.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7455.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13510.09, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10885.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10483, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7086.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12825.75 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7512.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 7455.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 7086.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7455.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7086.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12694.88 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11556.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11929.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12694.88 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12694.88 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13087.5 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12956.63 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7086.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12694.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7455.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10421.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13087.5 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12266, "minimum": 6117.3, "maximum": 22227.351, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 11646.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19927.97 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 11879.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19927.97 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 11646.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11646.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11762.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19517.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15946.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22227.35, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17909.46, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17247.05, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11646.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20133.41 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12345.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 12266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11646.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11646.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19927.97 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19013.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 19626.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19927.97 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19927.97 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20544.3 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20338.86 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11646.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19927.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6117.3 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20544.3 } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 3", "code_information": [ { "code": "4693", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8886.82, "maximum": 9775.5, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9775.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACHR BLOCKING ABS, SERUM LC", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.88, "discounted_cash": 18, "minimum": 5.4437, "maximum": 180, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6503, "minimum": 5850, "maximum": 26644.3248, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 6183.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9617.94 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 6307.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9617.94 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 6183.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6183.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6245.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9419.63 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8454.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 6503.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 6503.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 11783.65, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9494.56, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9143.39, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6183.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9717.09 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6554.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 6503.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6183.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6503.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6183.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9617.94 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 10079.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10404.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9617.94 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9617.94 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9915.4 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9816.25 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6183.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9617.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6503.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7896.23 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9915.4 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8411, "minimum": 3922.78, "maximum": 15242.0729, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 7992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11620.7 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 8152.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11620.7 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 7992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8072.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11381.1 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10935.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 8411.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 8411.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15242.07, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12281.14, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11826.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11740.5 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8472.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 8411.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 7992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8411.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11620.7 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13038.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13458.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11620.7 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11620.7 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11980.1 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11860.3 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7992.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11620.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8411.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3922.78 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11980.1 } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 4", "code_information": [ { "code": "4694", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17070.79, "maximum": 18777.87, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18777.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACHR MODULATING ABS", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 18, "minimum": 5.4437, "maximum": 180, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADAMTS13 PROFILE LC", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121, "discounted_cash": 30, "minimum": 24.68, "maximum": 121, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 30.86 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.06 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 47.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 1", "code_information": [ { "code": "1901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6639.41, "maximum": 7303.35, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7303.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15211.37, "maximum": 16732.51, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16732.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACOUS ELECTR CARDGRAPHY SINGLE", "code_information": [ { "code": "93799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408.96, "discounted_cash": 164, "minimum": 42.4472, "maximum": 408.96, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 240.43, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 329.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 258.55, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9772, "minimum": 8706.8471, "maximum": 17708.6579, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14268.57, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13740.82, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9282.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15955.18 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9839.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 9772.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 9282.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9772.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9282.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15792.38 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15148.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 15636.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15792.38 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15792.38 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16280.8 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16117.99 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9282.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15792.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9772.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13012.6 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16280.8 }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 9282.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15792.38 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 9468.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15792.38 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 9282.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9282.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9375.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15466.76 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12704.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 9772.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 9772.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17708.66, "additional_payer_notes": "181.20% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25746.65, "maximum": 28321.32, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28321.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACROMIO-CLVICULAR JTS,BI", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 799, "discounted_cash": 111, "minimum": 26.75, "maximum": 799, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 43.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.43 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADDITIONAL AB FLOW CLARIENT - 88185 - 45288185", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14, "minimum": 3.0632, "maximum": 21, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 } ] } ] }, { "description": "ADAPTER, LUER STUB PINK", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21687, "minimum": 14683.9995, "maximum": 39297.3695, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 20575.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36592.38 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 20986.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36592.38 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 20575.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20575.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 20781.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35837.9 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28193.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 21687.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 21687.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 39297.37, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31663.44, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 30492.33, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20575.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36969.62 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21809.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 21687.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 20575.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21687.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20575.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36592.38 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 33615.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 34699.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36592.38 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36592.38 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37724.1 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37346.86 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20575.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36592.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21687.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25569 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37724.1 } ] } ] }, { "description": "ADDITIONAL AB FLOW PI", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21, "minimum": 3.0632, "maximum": 21, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.68 } ] } ] }, { "description": "ADENOVIRUS GROUP AB, QN LC", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.14, "discounted_cash": 12, "minimum": 2.875, "maximum": 165, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12840, "minimum": 10800, "maximum": 57848.5763, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21769.71 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 12434.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21769.71 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21320.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16692.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12840.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12840.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 23267.29, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18747.38, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 18053.98, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21994.14 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12921.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 12840.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 12190.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12840.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21769.71 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19903.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 20545.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21769.71 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21769.71 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22443 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22218.57 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12190.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21769.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12840.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17871.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22443 } ] } ] }, { "description": "ACTIVATED PROTEIN C RESIS LC", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.25, "discounted_cash": 15, "minimum": 6.8375, "maximum": 31.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.62 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.05, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.05, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.54 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.99 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.05, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADDL VES PTA TIBIAL/PERONEAL", "code_information": [ { "code": "37232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21184.9, "minimum": 171.77, "maximum": 21184.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 180.36 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 171.77 } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2180.63, "maximum": 2398.69, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2398.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7771, "minimum": 7385.93, "maximum": 23850.8128, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12422.5 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 7533.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12422.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12166.37 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10102.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7771.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7771.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14081.87, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11346.32, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10926.66, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12550.57 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7829.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 7771.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 7385.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7771.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12422.5 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12045.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12434.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12422.5 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12422.5 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12806.7 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12678.63 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7385.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12422.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11672 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12806.7 } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8140.51, "maximum": 8954.56, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8954.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADH PROFILE", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.45, "discounted_cash": 33, "minimum": 6.3868, "maximum": 34.45, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.45 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.45, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20615, "minimum": 8334.7802, "maximum": 37354.4344, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 20615.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 20615.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 37354.43, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30097.94, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 28984.73, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19559, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33845.38 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20732.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 20615.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 19559, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20615.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19559, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33500.02 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 31953.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 32984.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33500.02 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33500.02 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34536.1 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34190.74 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19559, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33500.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20615.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35828.3 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34536.1 }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 19559, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33500.02 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 19950.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33500.02 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 19559, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19559, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 19754.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32809.3 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26799.54, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 3", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13200.37, "maximum": 14520.41, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14520.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADHESIVE,SKIN,DERMABND", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ADAPTER, LUER STUB YELLOW", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9881, "minimum": 9385.58, "maximum": 17904.8069, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 9385.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16772.27 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 9573.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16772.27 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 9385.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9385.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16426.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12845.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 9881.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 9881.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17904.81, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14426.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13893.02, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9385.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16945.18 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9948.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 9881.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 9385.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9881.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9385.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16772.27 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15315.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 15809.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16772.27 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16772.27 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17291 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17118.09 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9385.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16772.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9881.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13769 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17291 } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 3", "code_information": [ { "code": "7553", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5442.55, "maximum": 5986.81, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5986.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADDL VES STNT/ATHEREC TIB/PERO", "code_information": [ { "code": "37235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21184.9, "minimum": 200, "maximum": 21184.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 351.23 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 334.5 } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 4", "code_information": [ { "code": "7564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10975.22, "maximum": 12072.74, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12072.74, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADM Pfizer covid vacc-1 dose", "code_information": [ { "code": "0001A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "minimum": 8.752, "maximum": 40, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 } ] } ] }, { "description": "ADENOVIRUS AG DFA", "code_information": [ { "code": "87260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.36, "discounted_cash": 14, "minimum": 4.4548, "maximum": 200, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.29 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 2", "code_information": [ { "code": "1452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4873.28, "maximum": 5360.61, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5360.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10090.03, "maximum": 11099.03, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11099.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 2", "code_information": [ { "code": "7552", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2936.48, "maximum": 3230.13, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3230.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10920.09, "maximum": 12012.1, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12012.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8594.23, "maximum": 9453.65, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9453.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 3", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9493.2, "maximum": 10442.52, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10442.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADMIN TIXAGEVIMAB/CILGAV", "code_information": [ { "code": "M0220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 752.5, "discounted_cash": 188, "minimum": 164.647, "maximum": 752.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 240.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 295.99, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 295.99, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 263.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 275.25, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 265.07, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 377.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 295.99, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.36, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AER TX DEMO AND/OR EVAL", "code_information": [ { "code": "94664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.14, "discounted_cash": 280, "minimum": 12.34, "maximum": 1016.1, "payers_information": [ { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 283.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.18, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 394.05, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 434.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 559.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.01, "additional_payer_notes": "157.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 4", "code_information": [ { "code": "1904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15137.17, "maximum": 16650.89, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16650.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22769, "minimum": 12150, "maximum": 41258.787, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 21601.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39043.96 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 22033.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39043.96 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 21601.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21601.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 21817.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38238.93 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29600.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 22769.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 22769.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 41258.79, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 33243.84, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 32014.27, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21601.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39446.47 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22897.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 22769.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 21601.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22769.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21601.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39043.96 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 35293.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 36431.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39043.96 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39043.96 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40251.5 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39848.99 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21601.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39043.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34447.2 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40251.5 } ] } ] }, { "description": "AFP BODY FLUID", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.8, "discounted_cash": 20, "minimum": 1.8226, "maximum": 46.88, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.8 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 28.13 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.35 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16768, "minimum": 11066.8831, "maximum": 30383.9603, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 15913, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28120.59 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 16231.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28120.59 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 15913, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15913, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16072.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27540.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21798.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 16768.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 16768.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 30383.96, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24481.56, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 23576.08, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15913, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28410.49 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16867.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 16768.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 15913, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16768.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15913, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28120.59 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 25990.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 26829.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28120.59 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28120.59 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28990.3 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28700.4 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15913, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28120.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16768.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19302.2 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28990.3 } ] } ] }, { "description": "ADRENAL ANTIBODIES", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 12, "minimum": 2.2515, "maximum": 118.75, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFP, SERUM, TUMOR MARKER LC", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.54, "discounted_cash": 16, "minimum": 7.3386, "maximum": 33.54, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.33, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.33, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.48 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.33, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.54 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADPT CATH", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24086.53, "maximum": 26495.18, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 26495.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8596, "minimum": 8167.98, "maximum": 17156.0168, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14007.19 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 8331.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14007.19 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8249.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13718.38 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11175.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 8596.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 8596.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15576.98, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12550.99, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12086.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14151.59 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8658.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 8596.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8596.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14007.19 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13324.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13754.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14007.19 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14007.19 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14440.4 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14296 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14007.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8596.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12659.1 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14440.4 } ] } ] }, { "description": "ADDITIONAL AB FLOW CLARIENT - 88185 - 45288183", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14, "minimum": 3.0632, "maximum": 21, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 45294.89, "maximum": 49824.38, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 49824.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46978, "minimum": 19350, "maximum": 86310.3, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 44545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 83720.99 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 45436.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 83720.99 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 44545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 44991.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 81994.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 61071.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 46978.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 46978.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 85124.55, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 68588.22, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 66051.39, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 44545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 84584.09 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 47218.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 46978.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 44545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 46978.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 44545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 83720.99 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 72816.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 75165.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 83720.99 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 83720.99 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 86310.3 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 85447.2 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 44545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 83720.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46978.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68728.4 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 86310.3 } ] } ] }, { "description": "ADDITIONAL AB PEROXIDASE MCARE", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "minimum": 8.752, "maximum": 57.58, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 } ] } ] }, { "description": "AFB ID BY SEQUENCING", "code_information": [ { "code": "87153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250, "discounted_cash": 115, "minimum": 54.7, "maximum": 250, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.03 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 107.67 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 102.54 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.03 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 173.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 115.36 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.43 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 90.23 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 82.03 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 82.03 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.03 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 178.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.03 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 115.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 151.97, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADDITIONAL AB PEROXIDASE PI", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "minimum": 8.752, "maximum": 57.58, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 } ] } ] }, { "description": "AFB ID DNA PROBE", "code_information": [ { "code": "87149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.95, "discounted_cash": 20, "minimum": 10.9291, "maximum": 49.95, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.48, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.48, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.29 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.48, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AIRWAY INHALATION TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 958, "discounted_cash": 280, "minimum": 16.78, "maximum": 1000, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 283.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.18, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 394.05, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 434.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 560.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADDL VES STNT TIBIAL/PERONEAL", "code_information": [ { "code": "37234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21184.9, "minimum": 200, "maximum": 21184.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 247.46 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 235.68 } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6797, "minimum": 6462.58, "maximum": 24953.2, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 6462.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10041.15 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 6591.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10041.15 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 6462.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6462.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6527.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 9834.12 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8836.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 6797.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 6797.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12316.58, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9923.96, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9556.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6462.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10144.67 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6850.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 6797.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6462.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6797.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6462.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10041.15 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 10535.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10875.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10041.15 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10041.15 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10351.7 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10248.18 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6462.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10041.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6797.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24953.2 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10351.7 } ] } ] }, { "description": "AIRWAY NASOPHARYGEAL", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "AG SCRN UNIT W/PT SER EA UNIT - 86902 - 41086902", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53, "discounted_cash": 458, "minimum": 2.62, "maximum": 137, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AIRWAY, GUEDEL SIZE 100MM", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "AG SCRN UNIT W/PT SER EA UNIT - 86902 - 41000589", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53, "discounted_cash": 458, "minimum": 2.62, "maximum": 137, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADHES TOPICAL SKIN", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "AG SCRN,RGNT SER,EA UNIT", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137, "discounted_cash": 458, "minimum": 2.62, "maximum": 137, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3856.64, "maximum": 4242.3, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4242.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37336, "minimum": 18450, "maximum": 73792.0644, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 35407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61113.49 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 36115.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 61113.49 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 35407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 35407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 35761.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 59853.42 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 48536.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 37336.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 37336.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 67653, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 54510.69, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 52494.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 35407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 61743.53 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 37531.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 37336.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 35407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37336.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 35407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 61113.49 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 57870.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 59737.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61113.49 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 61113.49 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 63003.6 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 62373.56 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 35407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 61113.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37336.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50170 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 63003.6 } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 4", "code_information": [ { "code": "7554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8638.75, "maximum": 9502.63, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9502.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8305.88, "maximum": 9136.47, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9136.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AIRWAY CATHETER GUIDE - Z7610 - 80027063", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ALBUMIN SERUM", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161, "discounted_cash": 4, "minimum": 1, "maximum": 161, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19303.36, "maximum": 21233.7, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21233.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AIRWAY CATHETER GUIDE - Z7610 - 80027071", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6686, "minimum": 4452, "maximum": 12116.7353, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 6358.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10692.12 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 6485.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10692.12 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 6358.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6358.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6421.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10471.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8693.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 6686.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 6686.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12116.74, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9762.93, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9401.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6358.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10802.34 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6739.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 6686.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6358.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6686.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6358.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10692.12 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 10364.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10699.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10692.12 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10692.12 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11022.8 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10912.57 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6358.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10692.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6686.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4888.27 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11022.8 } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 3", "code_information": [ { "code": "7723", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6860.97, "maximum": 7547.07, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7547.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL,METHYL", "code_information": [ { "code": "84600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.41, "discounted_cash": 17, "minimum": 2.9341, "maximum": 41, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.41 } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 4", "code_information": [ { "code": "7724", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18947.17, "maximum": 20841.89, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20841.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7751", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3288.43, "maximum": 3617.27, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3617.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 3", "code_information": [ { "code": "2803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9753.98, "maximum": 10729.38, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10729.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7752", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4746.07, "maximum": 5220.68, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5220.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALDOLASE LC", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.42, "discounted_cash": 9, "minimum": 4.2491, "maximum": 19.42, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.25 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.67 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ETHANOL - G0480 - 41021400", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "discounted_cash": 114, "minimum": 63.95, "maximum": 572.15, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 67.15 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.66, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 179.66, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 70.35 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 179.66, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGENS REGION 13", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 663.25, "discounted_cash": 5, "minimum": 1, "maximum": 663.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 169.88, "10th_percentile": 169.88, "90th_percentile": 236.13, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18208, "minimum": 10176, "maximum": 32993.0228, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 17277.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30508.83 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 17623.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30508.83 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 17277.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17277.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 17450.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29879.78 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23670.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 18208.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 18208.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 32993.02, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26583.78, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 25600.55, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17277.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30823.35 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18314.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 18208.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 17277.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18208.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17277.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30508.83 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 28222.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 29132.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30508.83 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30508.83 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31452.4 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31137.88 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17277.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30508.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18208.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14853.6 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31452.4 } ] } ] }, { "description": "ALK PHOSPHATASE, BONE SPEC LC", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30, "discounted_cash": 14, "minimum": 2.6847, "maximum": 44.34, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.8 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.81 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 2", "code_information": [ { "code": "8112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4082.45, "maximum": 4490.69, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4490.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9402, "minimum": 6996, "maximum": 17036.9676, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 8931.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15113.86 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 9110.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15113.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 8931.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8931.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9020.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14802.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12222.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 9402.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 9402.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17036.97, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13727.36, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13219.63, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8931.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15269.67 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9467.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 9402.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8931.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9402.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8931.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15113.86 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14573.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 15043.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15113.86 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15113.86 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15581.3 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15425.49 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8931.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15113.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15581.3 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14676, "minimum": 6750, "maximum": 41991.7834, "payers_information": [ { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13930.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14070.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24044.03 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19079.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 14676.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 14676.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26594.33, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21428.1, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 20635.55, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13930.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24803.31 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14766.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 14676.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 13930.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14676.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13930.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24550.22 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22749.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 23482.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24550.22 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24550.22 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25309.5 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25056.41 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13930.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24550.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14676.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20889.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25309.5 }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 13930.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24550.22 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 14209.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24550.22 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 13930.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PROFILE COASTAL CA", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116, "discounted_cash": 5, "minimum": 1, "maximum": 663.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 169.88, "10th_percentile": 169.88, "90th_percentile": 236.13, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17559, "minimum": 8022.9183, "maximum": 31818.0133, "payers_information": [ { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30694.7 }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 16663.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29773.86 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 16996.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29773.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 16663.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16663.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16829.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29159.97 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22827.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 17559.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 17559.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 31818.01, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25637.03, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 24688.81, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16663.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30080.81 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17662.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 17559.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 16663.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17559.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16663.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29773.86 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27217.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 28095.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29773.86 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29773.86 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30694.7 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30387.75 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16663.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29773.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17559.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19510 } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6415.73, "maximum": 7057.3, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7057.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13076.33, "maximum": 14383.96, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14383.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGENS(20)+IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 566.25, "discounted_cash": 5, "minimum": 1, "maximum": 663.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 169.88, "10th_percentile": 169.88, "90th_percentile": 236.13, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 2", "code_information": [ { "code": "0072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 66446.01, "maximum": 73090.61, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 73090.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN PROFILE BASIC FOODS", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.71, "discounted_cash": 5, "minimum": 1, "maximum": 663.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 169.88, "10th_percentile": 169.88, "90th_percentile": 236.13, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 3", "code_information": [ { "code": "8113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8023.9, "maximum": 8826.29, "payers_information": [ { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8826.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 4", "code_information": [ { "code": "0074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 149835.59, "maximum": 164819.15, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 164819.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN SPEC IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4.5, "discounted_cash": 5, "minimum": 1, "maximum": 663.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 169.88, "10th_percentile": 169.88, "90th_percentile": 236.13, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AEROB BACT DEFINITIVE ID", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 8, "minimum": 2.4309, "maximum": 92, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.65 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 252.6, "10th_percentile": 201.6, "90th_percentile": 355.2, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7191, "minimum": 5596.55, "maximum": 18885.1044, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 6836.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11377.42 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 6972.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11377.42 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 6836.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6836.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6904.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11142.84 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9348.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7191.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7191.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13030.83, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10499.46, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10111.12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6836.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11494.71 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 7191.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 6836.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7191.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6836.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11377.42 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11146.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11506.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11377.42 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11377.42 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11729.3 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11612.01 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6836.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11377.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7191.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5596.55 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11729.3 } ] } ] }, { "description": "ALPHA-1-ANTITRYPSIN, SERUM LC", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5.26, "discounted_cash": 13, "minimum": 1.1509, "maximum": 85.8, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 4", "code_information": [ { "code": "8114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15162.61, "maximum": 16678.87, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16678.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AEROSOL TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.14, "discounted_cash": 280, "minimum": 16.78, "maximum": 1000, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 283.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.18, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 394.05, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 434.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 559.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 440.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 123113, "minimum": 116706, "maximum": 231403, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 116706, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 224460.91 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 119040.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 224460.91 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 116706, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 116706, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 117873.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 219832.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 160047.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 123113.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 123113.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 223081.64, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 179745.7, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 173097.57, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 116706, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 226774.94 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 123708.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 123113.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 116706, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 123113.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 116706, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 224460.91 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 190825.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 196981.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 224460.91 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 224460.91 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 231403 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 229088.97 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 116706, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 224460.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 123113.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 148818 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 231403 } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4892.36, "maximum": 5381.6, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5381.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALPHA SUBUNIT (FREE) LC", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.44, "discounted_cash": 17, "minimum": 3.7196, "maximum": 316.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFP WITH AFP-L3%", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.38, "discounted_cash": 64, "minimum": 35.5287, "maximum": 162.38, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.04 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.56 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 101.12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 60.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 57.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 101.12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 1", "code_information": [ { "code": "0071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 55309.66, "maximum": 60840.63, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 60840.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALUMINUM, PLASMA/SERUM LC", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.32, "discounted_cash": 25, "minimum": 2.9144, "maximum": 13.32, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALPHA SUBUNIT FREE", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.44, "discounted_cash": 17, "minimum": 3.7196, "maximum": 316.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12536, "minimum": 7558.1357, "maximum": 31255.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18485.48 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 12140.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18485.48 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 12021.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18104.34 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16297.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12536.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12536.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22715.87, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18303.07, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17626.11, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18676.06 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12616.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 12536.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12536.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18485.48 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19431.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 20058.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18485.48 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18485.48 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19057.2 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18866.63 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18485.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12536.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31255.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19057.2 } ] } ] }, { "description": "ALPHA 1 ANTITRYPSIN PHENOTYPE", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.5, "discounted_cash": 14, "minimum": 2.0173, "maximum": 18.5, "payers_information": [ { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 2", "code_information": [ { "code": "0522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6485.69, "maximum": 7134.26, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7134.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11886, "minimum": 9679.7599, "maximum": 21539.0084, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 11286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19508.25 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 11512.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19508.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 11286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11399.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19106.02 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15452.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 11886.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 11886.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 21539.01, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17354.83, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16712.94, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19709.37 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11963.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 11886.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11886.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19508.25 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18424.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 19018.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19508.25 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19508.25 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20111.6 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19910.48 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11286.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19508.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11886.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19762.1 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20111.6 } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 3", "code_information": [ { "code": "0523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9100.96, "maximum": 10011.06, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10011.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 396, "discounted_cash": 14, "minimum": 14.57, "maximum": 396, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.49 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.35 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMEBIASIS ANTIBODIES LC", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.45, "discounted_cash": 12, "minimum": 7.0016, "maximum": 37.45, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.31 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.49 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.09 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.42 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19431, "minimum": 13559.3701, "maximum": 35209.8055, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 18437.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31802.23 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 18805.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31802.23 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 18437.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18437.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 18621.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31146.51 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25260.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 19431.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 19431.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 35209.81, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28369.93, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 27320.63, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18437.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32130.08 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19543.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 19431.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 18437.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19431.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18437.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31802.23 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 30118.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 31090.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31802.23 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31802.23 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32785.8 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32457.94 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18437.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31802.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19431.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26107.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32785.8 } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 4", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15262.26, "maximum": 16788.49, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16788.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMIKACIN", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 549, "discounted_cash": 15, "minimum": 14.17, "maximum": 549, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.88 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.68, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.68, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.68, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AGGLUTININS,FEBRIL,EQ QL", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.88, "discounted_cash": 6, "minimum": 5.32, "maximum": 70.88, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.81 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.71 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINE CONFIRM GC/MS BLOO", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.02, "discounted_cash": 24, "minimum": 4.1025, "maximum": 314.85, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.55 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.17 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.37 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMINO ACID PROFILE, QN, PL LC", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.52, "discounted_cash": 16, "minimum": 16.87, "maximum": 140.18, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.81 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 22.68 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMINO ACID PROFILE URINE", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.18, "discounted_cash": 16, "minimum": 16.87, "maximum": 140.18, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.81 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 22.68 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS SNGL QUANT", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136, "discounted_cash": 22, "minimum": 2.1333, "maximum": 136, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.08, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.08, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.31 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.08, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMNIOCENTESIS", "code_information": [ { "code": "76946", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 975, "minimum": 17.26, "maximum": 975, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.99 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.26 } ] } ] }, { "description": "AMIODARONE QUANT", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.8, "discounted_cash": 18, "minimum": 3.282, "maximum": 83.03, "payers_information": [ { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.19 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 2", "code_information": [ { "code": "7722", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4532.99, "maximum": 4986.29, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4986.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMOEBIC AB", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32, "discounted_cash": 12, "minimum": 7.0016, "maximum": 37.45, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.31 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.49 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.09 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.42 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12439, "minimum": 10901.7, "maximum": 22540.0841, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 11810.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19926.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 12046.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19926.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 11810.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11810.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11928.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19515.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16171.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12439.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12439.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22540.08, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18161.44, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17489.71, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11810.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20131.75 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12518.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 12439.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11810.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12439.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11810.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19926.32 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19280.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 19902.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19926.32 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19926.32 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20542.6 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20337.17 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11810.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19926.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12439.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10901.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20542.6 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14843, "minimum": 9325.47, "maximum": 34200, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 14088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24805.52 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 14370.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24805.52 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 14088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14229.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24294.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19296.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 14843.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 14843.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26895.93, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21671.12, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 20869.58, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25061.25 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14933.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 14843.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 14088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14843.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24805.52 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23007.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 23749.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24805.52 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24805.52 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25572.7 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25316.97 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 24805.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14843.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9325.47 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25572.7 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9407.33, "maximum": 10348.06, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10348.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 1", "code_information": [ { "code": "2801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4881.76, "maximum": 5369.94, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5369.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 4", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31219.94, "maximum": 34341.93, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 34341.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 4", "code_information": [ { "code": "2804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19238.69, "maximum": 21162.56, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21162.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "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": 36000, "minimum": 22520.2823, "maximum": 68263.3, "payers_information": [ { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 34141.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34141.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 34482.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 64850.14 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 46800.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 36000.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 36000.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 65232.67, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 52560.54, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 50616.52, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 34141.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 66898.03 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 36189.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 36000.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 34141.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36000.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 34141.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 66215.4 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 55800.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 57600.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66215.4 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 66215.4 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 68263.3 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 67580.67 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 34141.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 66215.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36000.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31109.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 68263.3 }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 34141.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66215.4 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 34823.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 66215.4 } ] } ] }, { "description": "ANA W/RFX", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 259, "discounted_cash": 12, "minimum": 1, "maximum": 259, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.42 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPUT JNT/PHLNX W/DIRECT CL SR", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7935.69, "discounted_cash": 4187, "minimum": 200, "maximum": 8591.3, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5351.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4271.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 393.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4229.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5862.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6114.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5887.92, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 412.37 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4438.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6490.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7935.69, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALDOSTERONE LCMS, SERUM LC", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 40, "minimum": 4.5948, "maximum": 81.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.98, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.98, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.29 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.98, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6668.03, "maximum": 7334.83, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7334.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23626, "minimum": 22413.3, "maximum": 42811.2905, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 22413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36959.04 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 22861.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36959.04 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 22413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 22637.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36197 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30714.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 23626.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 23626.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 42811.29, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34494.75, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 33218.92, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37340.06 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23758.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 23626.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 22413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23626.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36959.04 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 36621.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 37802.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36959.04 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36959.04 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38102.1 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 37721.08 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 36959.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23626.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26492.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 38102.1 } ] } ] }, { "description": "ALDOSTERONE URINE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21, "discounted_cash": 40, "minimum": 4.5948, "maximum": 81.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": 29496, "minimum": 16669.5604, "maximum": 53447.4224, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 27976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49892.05 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 28536.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49892.05 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 27976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 28256.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 48863.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38345.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 29496.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 29496.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 53447.42, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43064.7, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 41471.9, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 27976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 50406.4 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 29655.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 29496.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 27976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29496.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 27976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49892.05 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 45719.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 47194.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49892.05 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49892.05 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51435.1 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 50920.75 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27976.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 49892.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29496.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26405.3 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 51435.1 } ] } ] }, { "description": "ANALY ANTITACH,ELECTRNC", "code_information": [ { "code": "93724", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 785.67, "discounted_cash": 393, "minimum": 138.05, "maximum": 785.67, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 589.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 502.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 414.15 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 394.43 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 589.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 617.15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.91, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 552.68, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 151.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 609.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 785.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 617.15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 3", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18500.87, "maximum": 20350.96, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20350.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGEN PROFILE ZONE 13", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104, "discounted_cash": 5, "minimum": 1, "maximum": 663.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 169.88, "10th_percentile": 169.88, "90th_percentile": 236.13, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": 50647, "minimum": 34322.8705, "maximum": 91773.0526, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 48023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 86292.46 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 48983.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 86292.46 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 48023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 48023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 48503.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 84513.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 65841.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 50647.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 50647.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 91773.05, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 73945.17, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 71210.22, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 48023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 87182.07 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 50904.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 50647.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 48023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50647.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 48023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 86292.46 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 78503.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 81035.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 86292.46 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 86292.46 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 88961.3 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 88071.69 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 48023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 86292.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50647.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50142.1 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 88961.3 } ] } ] }, { "description": "Amputation thru metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26250, "discounted_cash": 4187, "minimum": 200, "maximum": 26250, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5351.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4271.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 635.31 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4229.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5862.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6114.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5887.92, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4438.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6490.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8375.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 26250, "discounted_cash": 4187, "minimum": 200, "maximum": 26250, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5351.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4271.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 635.31 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4229.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5862.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6114.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5887.92, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4438.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6490.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8375.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 1", "code_information": [ { "code": "8111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2829.41, "maximum": 3112.35, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3112.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION JNT/PHLNX W/DIRECT", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8591.3, "discounted_cash": 4187, "minimum": 200, "maximum": 8591.3, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5351.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4271.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 393.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4229.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5862.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6114.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5887.92, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 412.37 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4438.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6490.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8375.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6574.7, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244, "discounted_cash": 6, "minimum": 5.3125, "maximum": 244, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 3", "code_information": [ { "code": "0073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 89273.14, "maximum": 98200.45, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 98200.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "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": 19486, "minimum": 17077.7503, "maximum": 35309.7373, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 18489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33092.33 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 18859.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33092.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 18489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 18489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 18674.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32410.01 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25332.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 19486.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 19486.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 35309.74, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28450.45, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 27398.17, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33433.48 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19598.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 19486.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 18489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19486.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33092.33 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 30204.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 31178.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33092.33 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33092.33 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34115.8 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33774.64 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18489.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 33092.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19486.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19260.4 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34115.8 } ] } ] }, { "description": "ANES 1ST 60 MIN", "code_information": [ { "code": "Z7506", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9116.1, "minimum": 146.17, "maximum": 9116.1, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 153.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 160.79 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 } ] }, { "setting": "outpatient", "gross_charge": 9116.1, "minimum": 146.17, "maximum": 9116.1, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 153.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 160.79 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 } ] } ] }, { "description": "ANA IFA", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.15, "discounted_cash": 12, "minimum": 2.2515, "maximum": 118.75, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS, QUAL", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.41, "discounted_cash": 13, "minimum": 3.3717, "maximum": 15.41, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": 14870, "minimum": 14114.7, "maximum": 34767.1834, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 14114.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21331.17 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 14396.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21331.17 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 14114.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14114.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14255.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20891.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19332.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 14870.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 14870.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26945.89, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21711.37, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 20908.34, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14114.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21551.08 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14961.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 14870.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 14114.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14870.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14114.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21331.17 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23049.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 23793.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21331.17 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21331.17 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21990.9 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21770.99 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14114.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21331.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14870.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17511.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21990.9 } ] } ] }, { "description": "ANES ADDL 15 MIN", "code_information": [ { "code": "Z7508", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5041.21, "minimum": 58.47, "maximum": 5041.21, "payers_information": [ { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 61.39 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 64.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 } ] } ] }, { "description": "ANAEROB DEFINITIVE ID", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 8, "minimum": 2.4309, "maximum": 92, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.17 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINE CONF GC/MS", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.95, "discounted_cash": 62, "minimum": 3.1201, "maximum": 359.15, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4020, "discounted_cash": 4187, "minimum": 200, "maximum": 4020, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 343.73 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 360.1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4020, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANG THR EXIT CATH AF THROM THP", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2948.91, "discounted_cash": 4041, "minimum": 99.85, "maximum": 4481.72, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 149.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 109.84 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13752, "minimum": 13054.8, "maximum": 30004.9679, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 13054.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21567.56 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 13315.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21567.56 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 13054.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13054.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13185.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21122.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17878.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 13752.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 13752.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 24919.69, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20078.78, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 19336.14, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13054.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21789.91 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13838.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 13752.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 13054.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13752.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13054.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21567.56 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21316.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 22004.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21567.56 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21567.56 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22234.6 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22012.25 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13054.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21567.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13752.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17026.6 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22234.6 } ] } ] }, { "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": 14524, "minimum": 13786.5, "maximum": 38444.5048, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 13786.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25867.67 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 14062.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25867.67 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 13786.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13786.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13924.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25334.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18882.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 14524.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 14524.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26318.61, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21205.95, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 20421.62, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13786.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26134.35 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 14524.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 13786.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14524.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13786.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25867.67 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22513.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 23239.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25867.67 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25867.67 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26667.7 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26401.02 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13786.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25867.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14524.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21235.7 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26667.7 } ] } ] }, { "description": "AMYLASE ISOENZYMES", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.28, "discounted_cash": 6, "minimum": 5.3125, "maximum": 244, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 2", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4834.06, "maximum": 5317.47, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5317.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANALYS IMP SPIN GEN", "code_information": [ { "code": "95970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 28.39, "maximum": 315.12, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.23 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 267.34, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.81 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.39 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.34, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 267.34, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.41, "additional_payer_notes": "140.60% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44226, "minimum": 41937.4, "maximum": 80137.6932, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 41937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 76832.15 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 42776.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 76832.15 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 41937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 42356.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 75247.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 57493.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 44226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 44226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 80137.69, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 64570.11, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 62181.9, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 41937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 77624.23 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 44453.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 44226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 41937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 44226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 41937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 76832.15 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 68550.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 70761.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 76832.15 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 76832.15 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 79208.4 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 78416.32 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 41937.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 76832.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44226.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 73088.3 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 79208.4 } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 4", "code_information": [ { "code": "2264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21704.49, "maximum": 23874.94, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 23874.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIO AORTA ABD W/LOWER EXT", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9818.61, "discounted_cash": 4041, "minimum": 104.04, "maximum": 9818.61, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4121.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 426.22 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 405.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 114.44 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8082.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANDROSTENEDIONE", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.56, "discounted_cash": 29, "minimum": 9.0933, "maximum": 202.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 39.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.17 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 2", "code_information": [ { "code": "3052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12581.27, "maximum": 13839.4, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13839.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23829, "minimum": 10482.8946, "maximum": 43179.5251, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 22605.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40548.13 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 23058.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40548.13 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 22605.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22605.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 22831.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39712.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30978.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 23829.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 23829.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 43179.53, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34791.45, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 33504.64, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22605.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40966.16 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23962.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 23829.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 22605.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23829.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22605.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40548.13 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 36936.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 38127.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40548.13 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40548.13 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41802.2 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41384.18 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22605.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 40548.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23829.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33286.6 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41802.2 } ] } ] }, { "description": "ANGIO EXTREMITY UNILAT", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 130.84, "maximum": 8505.98, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4121.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 397.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 378.19 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANDROSTENEDIONE LCMS LC", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.5, "discounted_cash": 29, "minimum": 9.0933, "maximum": 202.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.81 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 39.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.97, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.97, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.17 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.97, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMYLASE URINE TIMED", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244, "discounted_cash": 6, "minimum": 5.3125, "maximum": 244, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7554, "minimum": 7180.74, "maximum": 25107.8932, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 7180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11963.3 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 7324.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11963.3 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 7180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7252.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11716.64 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9821.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7554.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7554.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13689.57, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11030.23, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10622.26, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12086.63 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7611.58, "additional_payer_notes": "106.00% 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": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 7554.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 7180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7554.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11963.3 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11710.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12087.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11963.3 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11963.3 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12333.3 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12209.97 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11963.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7554.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8365.04 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12333.3 } ] } ] }, { "description": "ANGIO VISC, SEL. EA VAS FAMILY", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2461, "discounted_cash": 7121, "minimum": 121.45, "maximum": 13129.6, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 388.93 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 370.41 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 133.6 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANA Ab DIRECT", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.27, "discounted_cash": 12, "minimum": 1, "maximum": 259, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.42 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 19.13, "10th_percentile": 19.13, "90th_percentile": 41.16, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6257.77, "maximum": 6883.55, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6883.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIO, PELVIC, SEL, ILIACS BRA", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1802, "discounted_cash": 7121, "minimum": 124.31, "maximum": 13129.6, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 388.93 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 370.41 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1802, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO PERIF ARTERY", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255, "discounted_cash": 7284, "minimum": 200, "maximum": 25425, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9308.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7430.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2058.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7357.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10198.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10635.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10241.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2156.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7721.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11290.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14568.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANA W/REFLEX LC", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4.16, "discounted_cash": 12, "minimum": 1, "maximum": 259, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 19.13, "10th_percentile": 19.13, "90th_percentile": 41.16, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO EXIST CATH P THRPY", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4481.72, "discounted_cash": 4041, "minimum": 99.85, "maximum": 4481.72, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4121.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 156.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 149.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 109.84 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOGRAM EXTREMITY,BILATERAL", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 143.37, "maximum": 10046.8, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4121.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 394.45 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 375.67 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 157.71 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO VISC,SEL. EA VAS FAMILY", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12794.9, "discounted_cash": 7121, "minimum": 121.45, "maximum": 13129.6, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10682.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9100.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7264.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 388.93 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 370.41 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10682.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10682.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7193, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11181.19, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11181.19, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9970.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10397.8, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10013.22, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 133.6 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7549.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12794.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11181.19, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 2", "code_information": [ { "code": "2262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8216.84, "maximum": 9038.52, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9038.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIO,ADD VESSEL COMP", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2584, "minimum": 87.74, "maximum": 3623.69, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 363.38 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 346.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.51 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 } ] } ] }, { "description": "ANGIOGRAM ADD'L CEREBRAL CERV", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2584, "minimum": 87.74, "maximum": 3623.69, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 363.38 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 346.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.51 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 3", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12875.97, "maximum": 14163.57, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14163.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOGRAPHY, INTERNAL MAMMARY", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2461, "discounted_cash": 4041, "minimum": 143.9, "maximum": 7478.22, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 590.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 562.57 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 158.29 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOGRAM EXTREMITY UNILAT", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 130.84, "maximum": 8505.98, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4121.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 397.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 378.19 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6344.59, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9277, "minimum": 7650, "maximum": 18356.5045, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15091.65 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 8989.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15091.65 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8901.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 14780.48 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12061.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 9277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 9277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16811.21, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13545.46, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13044.46, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15247.23 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 9277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 8813.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15091.65 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14380.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14844.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15091.65 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15091.65 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15558.4 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15402.82 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15091.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9350.8 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15558.4 } ] } ] }, { "description": "ANGIOGRAPHY, ADRENAL, SEL. BIL", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2542, "discounted_cash": 4041, "minimum": 148.76, "maximum": 2542, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 394.67 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 375.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 163.64 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2542, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOGRAPHY, SPINAL, SELECTIVE", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2461, "discounted_cash": 7121, "minimum": 169.78, "maximum": 2461, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 169.78 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 423.22 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 403.07 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 169.78 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 169.78 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 186.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 169.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 169.78 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 169.78 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 169.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 169.78 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 169.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOPL TRNLM AORTIC PERC - 37246 - 752035472", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255, "discounted_cash": 7284, "minimum": 200, "maximum": 25425, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9308.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7430.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2058.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7357.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10198.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10635.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10241.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2156.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7721.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11290.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14568.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANCA Profile", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.58, "discounted_cash": 12, "minimum": 2.2515, "maximum": 118.75, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE 2V,LT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339, "discounted_cash": 111, "minimum": 19.92, "maximum": 474, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.64 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 284.4, "10th_percentile": 284.4, "90th_percentile": 284.4, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOPL TRNLM AORTIC PERC - 37246 - 45735472", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20964.9, "discounted_cash": 7284, "minimum": 200, "maximum": 25425, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9308.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7430.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2058.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7357.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10198.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10635.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10241.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2156.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7721.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11290.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14568.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOPL TRNLM BRACHIOCEPH PERC - 37247 - 45735475", "code_information": [ { "code": "37247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20964.9, "minimum": 200, "maximum": 22696.1, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 900.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 857.97 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 868.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 } ] } ] }, { "description": "ANKLE LIMITED - 73600 - 67100594", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272, "discounted_cash": 111, "minimum": 19.92, "maximum": 474, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.64 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 284.4, "10th_percentile": 284.4, "90th_percentile": 284.4, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOPL TRNLM BRACHIOCEPH PERC - 37247 - 752035475", "code_information": [ { "code": "37247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12576.6, "minimum": 200, "maximum": 22696.1, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 900.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 857.97 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 868.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 } ] } ] }, { "description": "ANGIOPL TRNLM RENAL VISC PERC - 37246 - 45735471", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20964.9, "discounted_cash": 7284, "minimum": 200, "maximum": 25425, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9308.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7430.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2058.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7357.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10198.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10635.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10241.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2156.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7721.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11290.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14568.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE, 3VW MIN", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 522, "discounted_cash": 111, "minimum": 26.32, "maximum": 522, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.86 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 36.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 156.6, "10th_percentile": 156.6, "90th_percentile": 156.6, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOPL TRNLM FEM/POP PERC", "code_information": [ { "code": "37224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255, "discounted_cash": 7142, "minimum": 200, "maximum": 15255, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10713.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9126.79, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7285.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 408.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 389.49 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10713.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10713.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7213.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11213.68, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11213.68, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9999.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10428.01, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10042.31, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7571.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11070.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14284.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11213.68, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE COMPLETE MIN 3V,RT", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381, "discounted_cash": 111, "minimum": 26.32, "maximum": 522, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.86 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 36.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 156.6, "10th_percentile": 156.6, "90th_percentile": 156.6, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 1", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4225.56, "maximum": 4648.12, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4648.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOPL TRNLM RENAL VISC PERC - 37246 - 752035741", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255, "discounted_cash": 7284, "minimum": 200, "maximum": 25425, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9308.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7430.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2058.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7357.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10198.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10635.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10241.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2156.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7721.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11290.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14568.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE,ARTHROGRAPHY", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1369.11, "discounted_cash": 446, "minimum": 79.92, "maximum": 1369.11, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 455.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 113.4 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 108 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 701.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 701.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 651.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.91 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 893, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 701.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANEROID, ADULT INFLATION SYSTE", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4360.09, "maximum": 4796.1, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4796.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOPL TRNLM VENOUS PERC - 37248 - 45735476", "code_information": [ { "code": "37248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20964.9, "discounted_cash": 7284, "minimum": 200, "maximum": 25425, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1487 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7721.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11290.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14568.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9308.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7430.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1419.41 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7357.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10198.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10635.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10241.91, "additional_payer_notes": "140.60% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 2", "code_information": [ { "code": "0592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7339.07, "maximum": 8072.98, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8072.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 1", "code_information": [ { "code": "1981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3984.92, "maximum": 4383.41, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4383.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13254.22, "maximum": 14579.64, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14579.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOPL TRNLM VENOUS PERC - 37248 - 752035476", "code_information": [ { "code": "37248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255, "discounted_cash": 7284, "minimum": 200, "maximum": 25425, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9308.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7430.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1419.41 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7357.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10198.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10635.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10241.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1487 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7721.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11290.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14568.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 3", "code_information": [ { "code": "0593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10738.81, "maximum": 11812.69, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11812.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 4", "code_information": [ { "code": "1984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10894.65, "maximum": 11984.11, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11984.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOTENSIN-CONVERTING ENZ LC", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.2, "discounted_cash": 14, "minimum": 6.389, "maximum": 29.2, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.52 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.54 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANS BREATH/CIR", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ANGIOGRAPH, ADRENAL, SEL. UNI'", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2461, "discounted_cash": 4041, "minimum": 136.04, "maximum": 2461, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 388.93 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 370.41 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 149.64 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE 3VW MIN", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272, "discounted_cash": 111, "minimum": 26.32, "maximum": 522, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.86 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 36.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 156.6, "10th_percentile": 156.6, "90th_percentile": 156.6, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANS FLTR", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "ANKLE 2V,RT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339, "discounted_cash": 111, "minimum": 19.92, "maximum": 474, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.64 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 284.4, "10th_percentile": 284.4, "90th_percentile": 284.4, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANT-THRMBNIII ACT", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.66, "discounted_cash": 11, "minimum": 5.1768, "maximum": 23.66, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.66 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOPL TRNLM ILIAC PERC", "code_information": [ { "code": "37220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255, "discounted_cash": 7142, "minimum": 200, "maximum": 15255, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10713.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9126.79, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7285.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 371.05 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 353.38 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10713.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10713.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7213.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11213.68, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11213.68, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9999.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10428.01, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10042.31, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7571.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11070.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14284.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11213.68, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7142.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9409.13, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-CARDIOLIPIN AB IGM", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.79, "discounted_cash": 25, "minimum": 2.3674, "maximum": 76.35, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE 3VW MIN, COMPLETE", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272, "discounted_cash": 111, "minimum": 26.32, "maximum": 522, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.86 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 36.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 156.6, "10th_percentile": 156.6, "90th_percentile": 156.6, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8566.24, "maximum": 9422.86, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9422.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOPL TRNLM RENAL VISC PERC - 37246 - 752035471", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255, "discounted_cash": 7284, "minimum": 200, "maximum": 25425, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9308.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7430.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2058.56 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7357.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10198.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10635.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10241.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2156.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7721.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11290.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14568.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1960.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-DNA(SS)IGG, AB, QN LC", "code_information": [ { "code": "86226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.46, "discounted_cash": 12, "minimum": 4.039, "maximum": 51, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.91 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.68 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE COMPLETE MIN 3V,LT", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381, "discounted_cash": 111, "minimum": 26.32, "maximum": 522, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.86 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 36.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 156.6, "10th_percentile": 156.6, "90th_percentile": 156.6, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3248.78, "maximum": 3573.66, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3573.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOPL TRNLM TIBIOPERON PERC", "code_information": [ { "code": "37232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12576.6, "minimum": 171.77, "maximum": 21184.9, "payers_information": [ { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 180.36 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 171.77 } ] } ] }, { "description": "ANTI-YO ANTIBODIES LC", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.45, "discounted_cash": 12, "minimum": 2.2515, "maximum": 118.75, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANLYS PCMKR ANTITACHYCARDIA", "code_information": [ { "code": "93724", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 785.67, "discounted_cash": 393, "minimum": 138.05, "maximum": 785.67, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 589.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 502.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 414.15 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 394.43 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 589.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 617.15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.91, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 552.68, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 151.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 609.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 785.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 617.15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.84, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6022.96, "maximum": 6625.26, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6625.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIOPLAS TRANSLM VENOUS", "code_information": [ { "code": "37248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255, "discounted_cash": 7284, "minimum": 200, "maximum": 25425, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9308.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7430.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1419.41 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10926.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7357.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10198.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10635.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10241.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1487 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7721.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11290.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14568.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11436.56, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1351.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7284.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9596.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY ID:PLATELET", "code_information": [ { "code": "86022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.63, "discounted_cash": 18, "minimum": 3.4198, "maximum": 62.51, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 4", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16561.94, "maximum": 18218.13, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18218.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTIBODY IDENTIFICATION PER BA", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32, "discounted_cash": 458, "minimum": 6.3452, "maximum": 600, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.61 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTEGRADE NEPHROSTOGRAM", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 758.22, "discounted_cash": 446, "minimum": 48.23, "maximum": 758.22, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 455.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 75.59 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 71.99 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 701.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 701.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 651.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 53.05 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 701.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE LIMITED - 73600 - 62158480", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247, "discounted_cash": 111, "minimum": 19.92, "maximum": 474, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.64 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 284.4, "10th_percentile": 284.4, "90th_percentile": 284.4, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY SCREEN, EACH TECHNIQU", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25, "discounted_cash": 66, "minimum": 2.98, "maximum": 225, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13219.02, "maximum": 14540.92, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14540.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANKLE,LIMITED", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 474, "discounted_cash": 111, "minimum": 19.92, "maximum": 474, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 113.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.64 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 284.4, "10th_percentile": 284.4, "90th_percentile": 284.4, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 174.85, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Anticardiolipin Ab IGM", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.35, "discounted_cash": 25, "minimum": 2.3674, "maximum": 76.35, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 29.66 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25639.21, "maximum": 28203.13, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28203.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTI DNASE B TITER", "code_information": [ { "code": "86215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.77, "discounted_cash": 13, "minimum": 3.4505, "maximum": 88.2, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY HRA DX W/ COLLECTION", "code_information": [ { "code": "46601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 571, "minimum": 68.9483, "maximum": 315.12, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 110.31 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 105.06 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIGLOMERULAR BM AB LC", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.79, "discounted_cash": 11, "minimum": 1.9167, "maximum": 220, "payers_information": [ { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2268.08, "maximum": 2494.89, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2494.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTI JO 1 ANTIBODY", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY HRA W/BIOPSIES", "code_information": [ { "code": "46607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2809.17, "discounted_cash": 1531, "minimum": 139.39, "maximum": 2809.17, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2297.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1957.03, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1562.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.36 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 139.39 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2297.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2297.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2404.52, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2404.52, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2144.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2236.05, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2153.35, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2373.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2809.17, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2404.52, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIPANCREATIC ISLET CELLS LC", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.27, "discounted_cash": 23, "minimum": 4.2163, "maximum": 62.69, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-CENTROMERE B ABS LC", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIPARIETAL CELL ANTIBODY LC", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.42, "discounted_cash": 11, "minimum": 1.9167, "maximum": 220, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-DSDNA ANTIBODIES LC", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27.48, "discounted_cash": 13, "minimum": 6.0126, "maximum": 191.1, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.15 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.24 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.57, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.57, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.06 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.57, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-SKELETAL MUSCL AB", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.9, "discounted_cash": 12, "minimum": 2.2515, "maximum": 118.75, "payers_information": [ { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.9, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.9, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.9, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTISCLERODERMA-70 ABS LC", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11.46, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTICARDIOLIPIN AB, IGA, QN LC", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.82, "discounted_cash": 25, "minimum": 2.3674, "maximum": 76.35, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTITRYPSIN, ALPHA1 STOOL", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.8, "discounted_cash": 13, "minimum": 1.1509, "maximum": 85.8, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.87 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.1, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.1, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.1, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTICARDIOLIPIN AB, IGG, QN LC", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.82, "discounted_cash": 25, "minimum": 2.3674, "maximum": 76.35, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 70624, "minimum": 19118.5, "maximum": 127970.7242, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 66957.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 114229.72 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 68296.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 114229.72 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 66957.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 66957.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 67626.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 111874.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 91811.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 70624.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 70624.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 127970.72, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 103111.07, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 99297.37, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 66957.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 115407.35 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 70974.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 70624.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 66957.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 70624.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 66957.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 114229.72 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 109467.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 112998.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 114229.72 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 114229.72 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 117762.6 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 116584.97 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 66957.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 114229.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 70624.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19118.5 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 117762.6 } ] } ] }, { "description": "ANTIHISTONE ANTIBODIES LC", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.72, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI MITOCHONDRIAL AB", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8.76, "discounted_cash": 12, "minimum": 1.9167, "maximum": 24.1, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR AB(ANA)TITER", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14, "discounted_cash": 11, "minimum": 3.0632, "maximum": 14, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APHASIA EVAL, PER HR", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360, "discounted_cash": 105, "minimum": 73.44, "maximum": 587, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 135.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 158.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.14, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.14, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 105.82 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 80.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 164.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.14, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-GLOMERULAR BSMNT", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.79, "discounted_cash": 17, "minimum": 3.7196, "maximum": 316.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.79, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR ANTIBODIES, IFA LC", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4.16, "discounted_cash": 12, "minimum": 1, "maximum": 259, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 19.13, "10th_percentile": 19.13, "90th_percentile": 41.16, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APLASTY,ADD VISCL ART", "code_information": [ { "code": "37247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7434, "minimum": 200, "maximum": 22696.1, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 900.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 857.97 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 868.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 789.65 } ] } ] }, { "description": "ANTI-HISTONE ANTIBODY", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.72, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIRIBOSOMAL P ABS", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35, "discounted_cash": 11, "minimum": 1.9167, "maximum": 220, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-GLIADIN AB", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36, "discounted_cash": 17, "minimum": 3.7196, "maximum": 316.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APP OF SKN SUB GRFT T/A/L ADD", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1836.87, "minimum": 36.49, "maximum": 1836.87, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.47 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 36.64 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 } ] } ] }, { "description": "ANTI-HU ANTIBODIES LC", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.45, "discounted_cash": 12, "minimum": 2.2515, "maximum": 118.75, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIBDY IDENT RBC EA PNL", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600, "discounted_cash": 458, "minimum": 6.3452, "maximum": 600, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 586.21, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 467.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.61 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 486.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24117.27, "maximum": 26529, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 26529, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTI-JO-1 LC", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTITHYROGLOBULIN AB LC", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8.11, "discounted_cash": 15, "minimum": 1, "maximum": 8.11, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7065.57, "maximum": 7772.13, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7772.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTI-RNP AB", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5.87, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIVERT - 00904651661", "drug_information": { "unit": 12.5, "type": "ME" }, "code_information": [ { "code": "00904651661", "type": "NDC" }, { "code": "J8597", "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": 790.59, "10th_percentile": 657.75, "90th_percentile": 1749.86, "count": "1 through 10" } ] } ] }, { "description": "ANTIBODY,INSULIN", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27.82, "discounted_cash": 66, "minimum": 2.98, "maximum": 225, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15844, "minimum": 13500, "maximum": 33137.1, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 15037, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25924.22 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 15337.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25924.22 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 15037, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15037, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15187.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25389.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20597.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 15844, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 15844, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 28709.33, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23132.24, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 22276.66, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15037, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26191.48 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15939.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 15844, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 15037, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15844, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15037, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25924.22 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24558.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 25350.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25924.22 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25924.22 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26726 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26458.74 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15037, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 25924.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15844, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33137.1 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26726 } ] } ] }, { "description": "ANTI-SIPHON PUMP SET (IPUMP)", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43514, "minimum": 6750, "maximum": 78847.966, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 41262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71281.42 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 42088.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 71281.42 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 41262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 41675.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 69811.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 56568.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 43514.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 43514.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 78847.97, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 63530.92, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 61181.15, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 41262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 72016.28 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 43738.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 43514.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 41262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43514.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 41262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 71281.42 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 67447.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 69622.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71281.42 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 71281.42 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 73486 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 72751.14 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 41262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 71281.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43514.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8690.67 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 73486 } ] } ] }, { "description": "ANTICARDIOLIPIN AB, IGM, QN LC", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.82, "discounted_cash": 25, "minimum": 2.3674, "maximum": 76.35, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-SMITH ANTIBODY", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11.2, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AORTOGRAPHY, THORACIC", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2461, "discounted_cash": 7121, "minimum": 98.32, "maximum": 12794.9, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 390.09 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 371.51 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 108.15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2461, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTICENTROMERE B AB", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPLICATION OF PASTE BOOT", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 705.75, "discounted_cash": 207, "minimum": 38.99, "maximum": 705.75, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 311.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.94 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 311.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 311.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 326.53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 291.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 292.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 42.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 326.53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Anticardiolipin Ab IGA", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.35, "discounted_cash": 25, "minimum": 2.3674, "maximum": 76.35, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 29.66 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APHASIA EVAL - 96105 - 58510017", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 587, "discounted_cash": 105, "minimum": 73.44, "maximum": 587, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 135.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 158.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 90 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 80.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 164.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIDIURETIC HORMONE PLASMA", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.19, "discounted_cash": 33, "minimum": 6.3868, "maximum": 34.45, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AQUA THER EA15", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134, "discounted_cash": 41, "minimum": 15.5129, "maximum": 241.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.98 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 90 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.22 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Anticardiolipin Ab IGG", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.35, "discounted_cash": 25, "minimum": 2.3674, "maximum": 76.35, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.14 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 29.66 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APOLIPOPROTEIN AI", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.41, "discounted_cash": 21, "minimum": 2.2777, "maximum": 138.34, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN TYPING", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104, "discounted_cash": 75, "minimum": 6.84, "maximum": 104, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.18 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.84 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.64 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTICHROMATIN ANTIBODIES LC", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.72, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15997.97, "maximum": 17597.77, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17597.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTIMULLERIAN HORMONE", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77, "discounted_cash": 17, "minimum": 3.7196, "maximum": 316.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC ENZYME PRETREATMENT", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.25, "discounted_cash": 218, "minimum": 3.7743, "maximum": 100, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIPHOSPHATIDYL CHOLINE", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 17, "minimum": 3.7196, "maximum": 316.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21609.08, "maximum": 23769.99, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 23769.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTINEURONAL AB,IGG", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56, "discounted_cash": 12, "minimum": 2.2515, "maximum": 118.75, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC PRE-RX W/CHEM/DRUG", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29, "discounted_cash": 75, "minimum": 6.3452, "maximum": 29, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.81 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIPHOSPHATIDYL INOSITOL", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 17, "minimum": 3.7196, "maximum": 316.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24843, "minimum": 22950, "maximum": 45016.9656, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 23567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42449.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 24038.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42449.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 23567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 23802.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41574.57 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32296.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 24843.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 24843.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 45016.97, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 36271.95, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 34930.38, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42887.45 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24981.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 24843.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 23567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24843.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42449.82 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 38507.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 39750.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42449.82 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42449.82 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43762.7 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43325.07 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 42449.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24843.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36852.1 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43762.7 } ] } ] }, { "description": "ANTINUCL AB (ANA)", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5.5, "discounted_cash": 12, "minimum": 1, "maximum": 259, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 19.13, "10th_percentile": 19.13, "90th_percentile": 41.16, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC-RBC ANTIBODY TITER", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70, "discounted_cash": 218, "minimum": 4.84, "maximum": 78, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.85 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.52 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIPHOSPHATIDYLSERINE AB", "code_information": [ { "code": "86148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.17, "discounted_cash": 16, "minimum": 15.1344, "maximum": 69.17, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.53, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.65 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.03 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR ANTIBODIES DIR LC", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4.16, "discounted_cash": 12, "minimum": 1, "maximum": 259, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 19.13, "10th_percentile": 19.13, "90th_percentile": 41.16, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ART STUDY LE W/EXER", "code_information": [ { "code": "93924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 954, "discounted_cash": 276, "minimum": 105.33, "maximum": 954, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 353.13, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 281.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 160.28 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 152.65 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 414.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 433.87, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.87, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 386.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 403.47, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 388.55, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 115.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 292.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 428.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 552.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.87, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTISTREPTOLYSIN O AB LC", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.6, "discounted_cash": 7, "minimum": 3.1945, "maximum": 141, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 9.12 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.26 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC ABO TYPE", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.25, "discounted_cash": 170, "minimum": 2.73, "maximum": 116, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 3.49 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIPHOSPHATIDIC ACID", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 17, "minimum": 3.7196, "maximum": 316.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTITHROMBIN ACTIVITY LC", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.66, "discounted_cash": 11, "minimum": 5.1768, "maximum": 23.66, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.66 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC ANTIBODY ID 6-8 SELECT CEL", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29, "discounted_cash": 458, "minimum": 6.3452, "maximum": 600, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.61 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIPHOSPHATIDYL ETHANOLAMINE", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 17, "minimum": 3.7196, "maximum": 316.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARTERIOVENOUS SHUNT", "code_information": [ { "code": "36905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31531.4, "discounted_cash": 14775, "minimum": 200, "maximum": 52552.3, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22162.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18879.79, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15070.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2175.83 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22162.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22162.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14922.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23196.75, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23196.75, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20685, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21571.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20773.65, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2279.44 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15661.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22901.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29550, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23196.75, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2072.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AORT/INF/IV/BPG COMP", "code_information": [ { "code": "93979", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1319, "discounted_cash": 133, "minimum": 75.1315, "maximum": 1319, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 119.48 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 113.79 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 106.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 207.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC ANTIGEN TYPE EA AG/UNIT", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52, "discounted_cash": 458, "minimum": 2.62, "maximum": 137, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.44 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTISCLERODERMA 70 AB", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11.46, "discounted_cash": 17, "minimum": 1.2844, "maximum": 53.79, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18000, "maximum": 36369.8405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30095.9 }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30095.9 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 29475.37 }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30406.17 }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30095.9 }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30095.9 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30095.9 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31026.7 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30716.43 }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30095.9 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24706.1 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31026.7 } ] } ] }, { "description": "ARC DILUTION OF SERUM", "code_information": [ { "code": "86976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.5, "discounted_cash": 37, "minimum": 7.5486, "maximum": 34.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.07 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 23.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIVERT - 00904651761", "drug_information": { "unit": 25, "type": "ME" }, "code_information": [ { "code": "00904651761", "type": "NDC" }, { "code": "J8597", "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": 790.59, "10th_percentile": 657.75, "90th_percentile": 1749.86, "count": "1 through 10" } ] } ] }, { "description": "ARTRIAL DOPLR UPR EXTR", "code_information": [ { "code": "93922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 50.82, "maximum": 954, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 78.47 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 74.73 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.34, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 267.34, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.41, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 55.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 267.34, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APHASIA EVAL - 96105 - 67210328", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 587, "discounted_cash": 105, "minimum": 73.44, "maximum": 587, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 135.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 158.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 90 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 80.78 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 164.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC MONOCYTE MONOLAYER ASSAY", "code_information": [ { "code": "86972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575, "discounted_cash": 218, "minimum": 17.0664, "maximum": 575, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 278.63, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.07 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 23.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.34, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 342.34, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.58, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 337.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 342.34, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AORTIC ARCH CANNULA", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8727.8, "maximum": 9600.58, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9600.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARC RETICULOCTYE SEPARATION", "code_information": [ { "code": "86972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78, "discounted_cash": 218, "minimum": 17.0664, "maximum": 575, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.07 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 23.88 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.02 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AORTIC ROOT CANN", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11244.48, "maximum": 12368.93, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12368.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARC RH TYPE", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8.5, "discounted_cash": 47, "minimum": 1.8598, "maximum": 230.44, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APP OF SKIN SUB GFT FA/NK/HF/G", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8576.8, "discounted_cash": 945, "minimum": 83.02, "maximum": 8576.8, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1418.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1208.7, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 964.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.24 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 83.09 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1418.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1418.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 955.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1485.08, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1485.08, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1324.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1381.03, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1329.95, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 91.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1002.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1466.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1891.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1485.08, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AS STPL AUTO", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1, "maximum": 2900, "payers_information": [ { "payer_name": "IN CUSTODY", "plan_name": "In Custody", "methodology": "fee schedule", "standard_charge_algorithm": "Not To Exceed $200", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 19.32, "10th_percentile": 19.32, "90th_percentile": 19.32, "count": "1 through 10" } ] } ] }, { "description": "APPLY MULTLAY COMPRS LWR LEG", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 705.9, "discounted_cash": 207, "minimum": 77.81, "maximum": 705.9, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 311.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 81.7 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 311.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 311.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 326.53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 326.53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 291.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 292.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 85.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 415.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 326.53, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC SPECIAL DAT (NEG INVEST)", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36, "discounted_cash": 75, "minimum": 1.9692, "maximum": 154, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.13 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 6.79 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.05 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9012.97, "maximum": 9914.27, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9914.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPLY RIGID LEG CAST", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1205.85, "discounted_cash": 357, "minimum": 195.98, "maximum": 1205.85, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 365.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 205.78 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 536.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 361.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 562.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 562.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 522.64, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.31, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 215.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 562.01, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARSENIC BLOOD", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.5, "discounted_cash": 18, "minimum": 5.1462, "maximum": 38.5, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.87 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 25.59 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.78, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.78, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.7 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.29 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.78, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13392.24, "maximum": 14731.46, "payers_information": [ { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14731.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ART/VEN FLOW ABD LTD - 93976 - 50620179", "code_information": [ { "code": "93976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1324, "discounted_cash": 133, "minimum": 133.8, "maximum": 1324, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 233.03 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 221.93 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 192.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 397.2, "10th_percentile": 397.2, "90th_percentile": 397.2, "count": "1 through 10" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 207.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.07, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 175.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12076, "minimum": 8550, "maximum": 21883.1797, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "case rate", "standard_charge_dollar": 11466.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19253.05 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "case rate", "standard_charge_dollar": 11695.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19253.05 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "case rate", "standard_charge_dollar": 11466.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11466.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11581.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 18856.08 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15699.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12076.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12076.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 21883.18, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17632.14, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16979.99, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11466.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19451.53 }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12154.49, "additional_payer_notes": "106.00% 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": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "case rate", "standard_charge_dollar": 12076.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "case rate", "standard_charge_dollar": 11466.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12076.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11466.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19253.05 }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18719.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 19322.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19253.05 }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19253.05 }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19848.5 }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19650.02 }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11466.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19253.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12076.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21314.3 }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19848.5 } ] } ] }, { "description": "ASP/INJ GANGLION CYST ANY LOC", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.1, "discounted_cash": 392, "minimum": 54.36, "maximum": 734.1, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 589.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 502, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 57.08 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 589.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 616.79, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 616.79, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.58, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 552.36, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 59.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 734.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 616.79, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC ANTIBODY SCRN EA TECH", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.5, "discounted_cash": 66, "minimum": 2.98, "maximum": 225, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASCORBIC ACID(VITAMIN C)", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.62, "discounted_cash": 9, "minimum": 2.7613, "maximum": 12.62, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.63, "discounted_cash": 15, "minimum": 2.9822, "maximum": 72.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "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": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARC RH PHENOTYPE COMPLETE", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.5, "discounted_cash": 47, "minimum": 5.1418, "maximum": 70, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Premier Physicians Network", "plan_name": "Premier Physcians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "PRIME HEALTH SERVICES", "plan_name": "Prime Health Services Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "Provider Network of America Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "Provider Select Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS PROVIDER NETWORK", "plan_name": "Three Rivers Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal ", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Compensation", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS FUMIGATUS AB lgG", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.25, "discounted_cash": 15, "minimum": 2.9822, "maximum": 72.25, "payers_information": [ { "payer_name": "Welbe Health PACE", "plan_name": "Welbe Health PACE Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Access Medical Group", "plan_name": "Access Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "AIDS Healthcare Foundation", "plan_name": "Aids Health Care Foundation MSSP Community Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "Americas Choice Provider Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.18 }, { "payer_name": "Anthem Blue Cross", "plan_name": "Anthem Blue Cross Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 20.17 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Avanti Hospitals, LLC", "plan_name": "Avanti Hospitals, LLC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Axminster Medical Group", "plan_name": "Axminster Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA Triwest Healthcare CCN", "plan_name": "Blue Shield Of CA TriWest Healthcare Community Care Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Blue Shield Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Commercial & Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "157.00% of Medicare Rates" }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "Centinela Valley IPA", "plan_name": "Centinela Valley IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "CORVEL", "plan_name": "Corvel Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% 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 Of CA", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal-Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal - IPA", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART PREFERRED NETWORK", "plan_name": "Healthsmart Preferred Network Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Imperial Health Plan", "plan_name": "Imperial Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medi-cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Kindred Hospital LA", "plan_name": "Kindred Hospital - LA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Covered CA and Covered Direct", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "L.A Care Health Plan", "plan_name": "L.A Care Health Plan Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN, INC. (dba CLARITEV) Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "OCCUNET", "plan_name": "OCCUNET Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Optum Health Plan Of California", "plan_name": "Optum Health Plan Of CA Medi-Cal", "methodology": "fe